Medicare Medical Review & Fraud Detection Analyst

Peraton

Reston (VA)

Remote

USD 66,000 - 106,000

Full time

14 days+

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Benefits offered by this job

Overtime eligibility

Discretionary bonus

Job summary

Peraton is seeking a Medical Review Analyst for Medicare to conduct medical record reviews and apply clinical judgment for payment decisions. The role involves researching regulations, identifying improper Medicare payments, and developing fraud cases with access to a range of data tools.

Responsibilities include presenting findings with regulatory violations, coordinating with external agencies, and possibly appearing in court.

Qualifications

Bachelor's degree with 5+ years of related experience or Master's with 3 years or Associate with 7 years
Active Nursing or Physical Therapy license in state of residence
3+ years in medical field as RN or clinician, or in review of medical claims
Strong investigative, communication, organization, and PC skills
U.S. citizenship is required

Responsibilities

Conduct medical record reviews and apply clinical judgment to claim decisions
Research regulations and cite violations
Uncover problems in Medicare payments and develop fraud cases
Present issues with regulatory violations and potential fraud, may testify in court
May coordinate with external agencies and respond to data requests
Overnight travel may be required; telework available from contiguous United States