Fraud Auditor Associate

Peraton; United States; Remoto; USD 52.000 - 74.000; Tempo pieno

Descrizione del lavoro

SafeGuard Services (SGS), a Peraton subsidiary, seeks an entry-level Fraud Auditor Associate to support high-level medical investigations and audits of provider activities.

You will work under a team manager, analyze data, prepare reports, and coordinate with state/federal investigators. Telework is available from the Eastern Time Zone, with travel as needed.

Competenze

• 0 years with BS/BA or 4 years with HS Diploma/equivalent
• Investigative and analytical experience
• Strong communication and organization skills
• US citizenship required

Mansioni

• Perform research and draw conclusions
• Document information in support of investigations and audits
• Organize a case file and document steps taken
• Prepare correspondence, reports and referral letters
• Educate providers, provider associations and other stakeholders on safeguards
• Communicate effectively internally and externally
• Interpret laws and regulations
• Handle confidential materials
• Report work activity timely
• Work under direct supervision as part of a team
• Attend meetings and travel as required
• Telework available from Eastern Time Zone

Conoscenze

Investigative experience

Communication

Organizational skills

PC proficiency

US citizenship

Formazione

BS/BA or equivalently 4 years HS diploma

Descrizione del lavoro

Basic Qualifications:

• 0 years with BS/BA or 4 years with a HS Diploma/equivalent
• Investigative and analytical experience
• Strong communication and organization skills
• Strong PC knowledge and skills
• US. citizenship required

The most competitive candidates will have:

• Strong background in investigations or compliance audits.
• Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases and identifying overpayments.
• Knowledge of investigative or audit practices regarding healthcare providers.
• Knowledge of Medicare and/or Medicaid programs and the rules, regulations, policies and procedures
• Background in evaluating, reviewing and analyzing medical claims and records
• Ability to learn and operate a variety of data systems, equipment and tools used in investigations

Essential Functions:

• Ability to perform research and draw conclusions
• Ability to document information in support of investigative/audit workload of the team, present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
• Ability to organize a case file, accurately and thoroughly document all steps taken
• Ability to compose correspondence, reports and referral summary letters
• Ability to educate providers, provider associations, law enforcement, other contractors and beneficiary advocacy groups on program safeguard matters
• Ability to communicate effectively, internally and externally
• Ability to interpret laws and regulations
• Ability to handle confidential material.
• Ability to report work activity on a timely basis.
• Ability to work under direct supervision as a member of a team to deliver high-quality work
• Ability to attend meetings, training conferences and overnight travel may be required.

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 Fraud Auditor Associate to our SGS team of talented professionals.

What you'll do:

The position is an entry level fraud investigator/auditor position expected to work under the direct supervision of a team manager and/or team lead. The team performs high level complex investigations of medical professional service providers and develops cases/reports for future action, including referral to law enforcement, education, over payment recovery and other administrative actions. This position will support the team of fraud investigators/auditors and will work with internal resources and external agencies to develop cases/audits and corrective actions as well as respond to requests for data and support.

• The auditor uses good judgment and will work under the direct supervision of team manager and/or team lead
• The audit associate will work in support of a team who works with state and/or federal investigators and other personnel.
• The auditor handles multiple caseload assignments concurrently; organizes and analyzes information in support of the team’s workload
• The auditor may also be required to assist in the completion of complex reports that apply regulations or rules to the program(s) affected by the behavior being reviewed.
• Auditor will work collaboratively within the team and participate in researching and understanding the relevant offenses being reviewed; participate in conducting efficient and effective investigations/audits concerning those alleged offenses and detect or verify suspected violations; obtain information and evidence by observation, record examination, and interview.
• Auditor will collaborate with team members to analyze the results of the investigation/audit to ascertain if the allegations have been corroborated and work with others to determine the appropriate steps that need to be taken to address the issues.
• As part of an audit, the auditor will need to prepare correspondence; be objective and accurate and communicate with others with tact.
• There may be times when auditors need to react to unplanned situations, be flexible in planning their activities and adopt effective courses of action.
• As auditors will be working with health privacy information, they also must maintain confidentiality and understand all the laws, rules and regulations concerning health privacy.
• Telework available from Eastern Time Zone