Medicare Medical Review Analyst – Remote Fraud Detection

Peraton; Idaho; Remote; USD 66,000 - 106,000; Full time

Benefits offered by this job

Telework available

Job summary

Peraton is seeking a Medical Review Analyst for SafeGuard Services. You will conduct medical record reviews and apply clinical judgment to determine claim payments, supporting fraud detection and investigations.

Responsibilities include researching regulations, identifying improper Medicare payments, and developing cases for action. Telework is available from the contiguous United States; U.S. citizenship is required.

Qualifications

• 5 years with BS/BA; 3 years with MS/MA; 0 years with PhD.
• Active Nursing or Physical Therapy license
• Experience reviewing medical claims for coverage and medical necessity
• U.S. citizenship required
• Strong investigative, communication, and organizational skills

Responsibilities

• Conduct medical record reviews and apply clinical judgment to determine claim payments.
• Research regulations and cite violations; identify fraud indicators.
• Develop cases for administrative action and coordinate with outside agencies; respond to data requests.
• Telework available from contiguous U.S.

Skills

Investigative skills

Communication skills

Organization skills

U.S. citizenship

Education

BS/BA

MS/MA

Registered Nurse license

Job description

Peraton is seeking a Medical Review Analyst for SafeGuard Services. You will conduct medical record reviews and apply clinical judgment to determine claim payments, supporting fraud detection and investigations.

Responsibilities include researching regulations, identifying improper Medicare payments, and developing cases for action. Telework is available from the contiguous United States; U.S. citizenship is required.