Fraud Referral Specialist - Medicare

Peraton; Florida; Remote; USD 39,000 - 62,000; Full time

Benefits offered by this job

Telework from Florida

Job summary

Peraton is seeking a Fraud Referral Specialist for its SafeGuard Services (SGS) team to perform data analysis, investigation, and medical review to detect, prevent, deter, reduce, and recover fraud, waste, and abuse in Medicare and Medicaid programs.

The role involves handling referrals, analyzing claims data, interviewing, and documenting case files, with a focus on timely follow-up actions. Telework is available from Florida; U.S. citizenship is required.

Qualifications

• HS diploma required; 0 years with BS/BA; 4 years with a HS Degree
• Strong interpersonal, analytical, research, and organizational skills are required
• Excellent verbal and written communications; self-driven and motivated; U.S. citizenship required

Responsibilities

• Perform research and draw conclusions
• Present issues of concern, citing regulatory violations and schemes to defraud the Government
• Organize a case file and document all steps taken
• Conduct background investigation on providers within the Medicare program
• Compose correspondence, reports, and referral summary letters
• Educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters
• Telework available from Florida

Skills

Interpersonal skills

Analytical skills

Research skills

Organizational skills

Verbal and written communication

Excel proficiency

Time management

Education

High School Diploma or GED

Tools

Excel

Job description

About Peraton

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 solve the most daunting challenges that our customers face. Visit peraton.com to learn how we're keeping people around the world safe and secure.

Program Overview

Performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse in Medicare and Medicaid programs.

About The Role

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 Referral Specialist to our SGS team of talented professionals.

What you'll do

The position requires the individual to use a variety of tools to assist in the evaluation of referrals and complaints, as well as development of investigations to identify potential fraud. Development of investigations commonly include responding to referrals from other entities, fielding requests for data and support, analyzing and interpreting claims data for aberrancies, conducting interviews, and reporting findings with a focus on taking quick and appropriate follow up actions. Follow up actions commonly include referrals to field investigative teams or to the data team for further analysis.

• Perform research and draw conclusions
• Present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
• Organize a case file, accurately and thoroughly document all steps taken
• Conduct background investigation on providers within the Medicare program
• Compose correspondence, reports, and referral summary letters
• Educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters
• Telework available from Florida

Qualifications

Basic Qualifications

• 0 years with BS/BA; 4 years with a HS Degree
• Strong interpersonal, analytical, research, and organizational skills are required
• Excellent verbal and written communications
• Strong PC knowledge and skills
• Strong use of Excel and being able to sort and filter data
• Strong time management and organizational skills required
• Self-driven and motivated
• U.S. citizenship required

Desirable Qualifications

The most competitive candidates will have

• 1 or 2 years of investigative or analytical experience preferred
• This position may require the incumbent to appear in court to testify about work findings.
• 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 independently and as a member of a team to deliver high-quality work
• Ability to attend meetings, training, and conferences, some overnight travel required

Details

Target Salary Range: $39,000 - $62,000. 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 at https://www.careers.peraton.com/benefits.

EEO

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