Medicaid Auditor/Investigator

Peraton; United States; Remote; USD 75,000 - 110,000; Full time

Job summary

SafGuard Services (SGS), a Peraton subsidiary, is seeking a Medicaid Auditor/Investigator to perform audits and data analyses on various Medicaid programs from a remote location in the United States. The role emphasizes independent judgment, adherence to regulations, and clear documentation of findings.

The candidate should bring experience in auditing, strong analytical skills, and knowledge of healthcare claims data.

Qualifications

• 2 years with BS/BA or 6 years with a HS diploma.
• Experience in accounting or closely related 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.
• Must be a US Citizen.
• This is a remote position.

Responsibilities

• Conduct audits and reviews of Medicaid programs to ensure compliance.
• Analyze data, interpret regulations, and identify compliance issues.
• Perform ad-hoc audits and evaluate billing patterns.
• Interview beneficiaries/recipients and document findings.
• Prepare reports, referrals and summary letters with recommendations.
• Collaborate with team members and provide progress updates on audits.

Skills

Auditing knowledge

Research and analysis

US Citizenship

Education

BS/BA in accounting or related field

HS diploma with 6 years experience

Tools

Excel

Microsoft Office

Job description

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

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 Auditor/Investigator 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.
• This is a remote position.