Medicaid Fraud Auditor

Peraton; United States; Remote; USD 70,000 - 90,000; Full time

Job summary

SafeGuard Services (SGS), a Peraton subsidiary, seeks a Medicaid Fraud Auditor to review Medicaid programs for compliance and recover over-payments. The role requires research, data analysis, and auditing skills, with strong Excel proficiency. Candidates must reside in the Northeast states listed and be US citizens.

The auditor will conduct varied audits, document findings, and present issues with regulatory references while working remotely as part of SGS’s Medicaid team.

Qualifications

• 2 years with BS/BA or 6 years with HS diploma
• Experience in accounting or closely related business field
• Knowledge of internal audit/investigative policies and operating principles
• Understanding of Medicare/Medicaid or healthcare auditing
• Strong Research and analytical skills
• Intermediate to advanced knowledge of Excel
• Must be a US Citizen

Responsibilities

• Conduct audits and reviews of various Medicaid programs to ensure compliance with federal and state requirements
• Recover over-payments for non-compliance through data analysis and testing
• Handle multiple assignments concurrently and organize billing patterns
• Document all steps thoroughly and maintain case files
• Present issues with data-backed findings and regulatory references
• Work independently or as part of a team and provide status updates
• Participate in meetings and trainings to grow business acumen
• This is a remote position serving the Northeast jurisdiction within specified states

Skills

Auditing

Data analysis

Research skills

Microsoft Excel

Interviews

US citizenship

Education

BS/BA

HS diploma

Tools

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 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.
• This is a remote position, candidates must reside within the Northeast Jurisdiction which include the states of Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, Pennsylvania, New Jersey, Delaware, Maryland, District of Columbia, and Virginia.