External Job Posting Title Medicaid Fraud Auditor

Peraton; Idaho; Teletrabalho; USD 51 000 - 82 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Telework from any state in the US

Medical, dental, vision benefits

401(k) plan

Resumo da oferta

Peraton is seeking a Medicaid Fraud Auditor for its SafeGuard Services (SGS) team to conduct audits of Medicaid programs, ensure compliance with federal/state requirements, and recover overpayments. You will analyze data, interview beneficiaries, and document findings in case files with adherence to policies and timelines.

Strong analytical skills and knowledge of Medicaid auditing are essential. This remote role offers telework from any state in the US, with potential for overtime and

Qualificações

• Experience in accounting, law enforcement, health science or related field.
• Knowledge of internal audit/investigative policies and principles.
• Understanding of Medicare/Medicaid or healthcare auditing.

Responsabilidades

• Conduct audits and reviews of Medicaid programs to ensure compliance.
• Identify overpayments and opportunities for improvements.
• Organize and document audit steps and findings; present issues with data-backed evidence.
• Interview beneficiaries/recipients and others as needed to obtain statements.
• Ensure timely, complete and accurate project delivery.

Conhecimentos

Analytical skills

Research skills

US citizenship

Formação académica

BS/BA in accounting or related field

High School diploma

Ferramentas

Microsoft Excel

Microsoft Office

Descrição da oferta de emprego

Peraton Overview

Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world’s leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can’t be done by solving the most daunting challenges facing our customers. Visit peraton.com to learn how we’re keeping people around the world safe and secure.

Responsibilities

SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.

We are looking to add a Medicaid Fraud Auditor to our SGS team of talented professionals.

What you'll do:

This individual will conduct audits and reviews of various Medicaid programs to ensure compliance with federal and state Medicaid program requirements and to recover over-payments for non-compliance. The individual applies intermediate level of subject matter knowledge to solve a variety of common business issues. Works on problems of moderately complex scope. Acts as an informed team member providing analysis of information and limited project direction input. Exercises independent judgment within defined practices and procedures to determine appropriate action. Follows established guidelines and correctly interprets policies. Evaluates unique circumstances and makes recommendations. Specifically,

• Provides research, interprets laws and regulations, performs data analysis and draws conclusions for projects;
• Conducts compliance audits of varied Medicaid case-types, audits claim submissions and performs ad-hoc focused audits;
• Handle several assignments concurrently; organizes and analyzes billing patterns; conducts interviews and obtains statements from beneficiaries/recipients and others;
• Develops an understanding of the function to be audited and uses business knowledge, analytical skills, and experience in identifying findings and making recommendations for improvements Identifies compliance exceptions, conflicts of interest, improper payments.
• Organizes a case file, accurately and thoroughly documents all steps taken;
• Works independently or at times as part of a team, provides ongoing progress reports and updates on audit status;
• Presents issues of concern, verified through data, citing regulatory violations, proving schemes or scams to defraud the Government;
• Compose correspondence, reports, and referral summary letters;
• Works under general supervision and as a member of a team delivering high-quality work;
• Ensures that projects are timely, complete and accurate.
• Actively participants at meetings and attends training to further his business acumen.
• Telework is available from any state in the US.

Qualifications

Required Qualifications:

• 2 years with BS/BA or 6 years with a HS diploma.
• Experience in accounting or closely related business field, law enforcement, health science or related field.
• Knowledge of internal audit/investigative policies and operating principles.
• Understanding of Medicare/Medicaid or healthcare auditing.
• Strong Research and analytical skills.
• Strong familiarity with Microsoft Office tools, including intermediate to advanced knowledge of Excel.
• Must be a US Citizen

Desirable Qualifications

• Intermediate financial and business acumen.
• Intermediate audit/investigative skills
• Project management skills.
• Knowledge of the healthcare industry and medical coding concepts and/or experience analyzing health care claims data is preferred

Target Salary Range

$51,000 - $82,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual’s experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.

Benefits Statement

Peraton offers eligible employees a variety of benefits including medical, dental, vision, life, health savings account, short/long term disability, EAP, parental leave, 401(k), paid time off (PTO) for vacation, and company paid holidays. A full listing of available benefits can be viewed athttps://www.careers.peraton.com/benefits.

EEO

EEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.