Medicare Operations Lead

Peraton; United States Virgin Islands; Remote; USD 80,000 - 100,000; Full time

Job summary

Join a forward-thinking company as a Medicare Operations Lead, where you will play a crucial role in managing healthcare fraud operations. This dynamic position involves overseeing complex investigations, ensuring compliance with Medicare requirements, and fostering strong relationships with key stakeholders. You will lead a talented team, motivating them to achieve excellence and meet contract goals. If you are passionate about making a difference in healthcare and possess strong leadership and communication skills, this opportunity is perfect for you. Embrace the challenge and contribute to meaningful change in the Medicare landscape!

Qualifications

• 8+ years of experience in management responsible for complex systems.
• In-depth knowledge of Medicare laws and regulations.

Responsibilities

• Manage staff activities in healthcare fraud, waste, and abuse.
• Oversee large-scale investigations and maintain business relations.

Skills

Leadership Skills

Knowledge of Medicare Program

Communication Skills

Organizational Skills

Problem-Solving Skills

Education

Bachelor's Degree

10+ years of Medicare Program Integrity Experience

Tools

MS Office Suite

Job description

Required Qualifications:

• A minimum of 8 or more years of professional experience, with at least 3 years in management capacity responsible for complex systems and workflows.
• Proven leadership skills and in-depth knowledge of the Medicare Program as it pertains to reviewing claims and provider behavior for indications of potential fraud, waste, and abuse.
• The individual must have knowledge of Medicare requirements, laws, rules, and regulations related to payment for services billed to the Program.
• The individual must demonstrate experience and knowledge in providing guidance to data analysts, investigators, and medical staff.
• Must be a US Citizen.

Desired Qualifications:

• A bachelor’s degree from an accredited institution. Education requirements may be substituted if the applicant has 10 or more years of related Medicare program integrity experience.
• Expert representational, oral, and written communication skills.
• Superior organizational and interpersonal skills and demonstrated ability to interface effectively via written and oral forums with personnel at all levels of government.
• Expert skills using MS Office Suite, including Outlook, Word, Excel, and PowerPoint.
• Ability to effectively work independently and as a member of a team.

Company Overview:

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.

Position Overview:

We are looking to add a Medicare Operations Lead to our team of talented professionals.

What you'll do:

This position requires experience in managing staff activities in healthcare fraud, waste, and abuse. Plan, direct, and monitor operations of CMS contract relative to the Medicare line of business. Recruit and support development of staff. The successful candidate will possess experience and knowledge in providing guidance to data analysts, investigators, and medical review staff to provide daily operational oversight and monitoring to assure CMS metrics are met. Maintain superior business relations with CMS, Law Enforcement, MACs, and all other stakeholders and partners. Oversee and coordinate large-scale multi-subject investigations involving organized criminal enterprises – including the execution of multiple simultaneous on-site visits to these providers’ offices in CMS designated High Risk Areas and coordinating projects with the Office of Inspector General (OIG), FBI, and Department of Justice. Successfully manage and ensure an adequate Quality Assurance (QA) program and process are in place and strictly adhered to for all tasks; and assure effective lines of communication exist with internal staff and external stakeholders. Excel at problem-solving, delegating, providing meaningful feedback, engaging in conflict resolution as appropriate, and motivating staff to meet the contract requirements.

Responsibilities:

• Proven ability to meet and exceed business goals and targets.
• Demonstrate leadership that encourages innovation.
• Accountable for the successful execution of the current business as well as for the growth and expansion of the Medicare accounts when available.
• Ability to motivate staff and evaluate performance.
• Plan resources to address workload needs, set priorities, and report unit activity.
• Assist in development, administration of, and oversight control of the Medicare budget.
• Administer corporate policies.
• Responsible for recruiting, interviewing, and hiring staff.
• Ability to oversee contract requirements for Medicare.
• Act as the primary point-of-contact for Medicare contractual issues and questions, escalating as appropriate to senior management.
• Ensure all contract requirements are met including quality, cost control, timeliness, and business relations for Medicare.
• Ability to maintain superior business relations with CMS, Law Enforcement, MACs, and all other stakeholders and partners.
• Telework available from all states in the US.