CMS Administrative Action Specialist – Telework (ET)

Peraton; United States; Remote; USD 65,000 - 95,000; Full time

Benefits offered by this job

Telework from EST

Job summary

SafeGuard Services (SGS), a Peraton subsidiary, seeks an Admin Action Specialist to manage administrative actions tied to CMS investigations. You will develop, submit, and coordinate actions while handling a high-volume workload and tight timelines.

The role emphasizes reviewing evidence, collaborating with CMS and law enforcement, and ensuring timely action through the Program Integrity Manual guidelines. Telework from the eastern time zone is available.

Qualifications

• 2 years with BS/BA or 6 years with a HS diploma/equivalent.
• Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed to the Program.
• Strong PC knowledge and skills.
• Experience in reviewing claims and medical reviews.
• Ability to educate providers, law enforcement and other stakeholders on program safeguards.
• Ability to interpret laws and regulations and handle confidential material.

Responsibilities

• Be CMS point of contact for all administrative actions related to investigations.
• Develop and submit actions to CMS for approval.
• Maintain high-volume workload with quick actions and metrics.
• Review evidence supporting administrative actions (suspensions, revocations, etc.).
• Coordinate with Investigative Teams, CMS, law enforcement, and MACs.
• Monitor timelines per Program Integrity Manual.
• Prepare and submit action packages for CMS/MAC approval.

Skills

Communication

Organizational skills

Research and analysis

Case documentation

Reviewing claims

Regulatory compliance

Independent work

Education

BS/BA with 2 years experience or HS diploma with 6 years

Tools

WMM (case management system)

Job description

SafeGuard Services (SGS), a Peraton subsidiary, seeks an Admin Action Specialist to manage administrative actions tied to CMS investigations. You will develop, submit, and coordinate actions while handling a high-volume workload and tight timelines.

The role emphasizes reviewing evidence, collaborating with CMS and law enforcement, and ensuring timely action through the Program Integrity Manual guidelines. Telework from the eastern time zone is available.