Medicare Administrative Action Specialist – Remote

Peraton; Herndon (VA); Remote; USD 51,000 - 82,000; Full time

Job summary

Peraton is seeking an Administrative Action Specialist to join SafeGuard Services (SGS). The role focuses on acting as the CMS point of contact for investigations and submitting action packages for approval, while managing a high-volume workload and ensuring timely actions.

Ideal candidates will have Medicare knowledge, strong communication skills, and experience in claims/medical reviews. Telework is available from the eastern time zone and duties include collaboration with CMS and law

Qualifications

• 2 years with BS/BA or 6 years with a HS diploma/equivalent
• Knowledge of Medicare requirements, laws and regulations related to payment for services billed to the Program
• Strong communication and organization skills
• Experience in reviewing claims, performing medical reviews, and/or developing fraud cases
• Strong PC knowledge and skills

Responsibilities

• Serve as a point of contact for CMS regarding all administrative actions related to investigations
• Develop and submit an action to CMS for approval
• Maintain a high-volume workload with quick actions and multiple metrics
• Work with Investigative Teams to ensure documentation supports administrative actions
• Collaborate with CMS, law enforcement and MACs throughout the action lifecycle
• Monitor workload to meet Program Integrity Manual timeframes
• Prepare and submit administrative action packages to CMS and MACs for approval and processing
• Telework available from eastern time zone

Skills

Strong communication

Organization skills

Medicare knowledge

Claims review/medical review

Education

BS/BA

HS diploma/equivalent

Job description

Peraton is seeking an Administrative Action Specialist to join SafeGuard Services (SGS). The role focuses on acting as the CMS point of contact for investigations and submitting action packages for approval, while managing a high-volume workload and ensuring timely actions.

Ideal candidates will have Medicare knowledge, strong communication skills, and experience in claims/medical reviews. Telework is available from the eastern time zone and duties include collaboration with CMS and law