Project Coordinator

Peraton; United States; Remote; USD 90,000 - 120,000; Full time

Job summary

SafeGuard Services (SGS), a Peraton subsidiary, seeks a Project Coordinator to support Medicaid Managed Care audit initiatives. You will bridge business needs with technical solutions, shaping data strategy, validation, and actionable insights.

Responsibilities include leading fraud/waste/abuse projects, developing methodologies, and coordinating with CMS, State Agencies, and internal teams. Remote work is available nationwide in the United States.

Qualifications

• 5 years with BS/BA; or 9 years with a HS Diploma/equivalent
• Healthcare policy and regulation experience (Medicaid preferred).
• Strong research skills.
• Strong communication and organization skills.
• Strong writing skills.
• Strong computer skills including Microsoft Access, experience in relational data base design, extract, and reporting, Excel, and the Internet
• Strong proven analytical ability and basic knowledge of statistics and sampling techniques
• Proven Ability to work with a variety of systems, sources of data and analytic tools
• Excellent organizational and communication skills
• US citizenship required

Responsibilities

• Leads projects resulting from the discovery of situations that potentially involve fraud, waste or abuse in Medicaid.
• Develop project methodologies arising out of the project idea including coordinating with internal teams to develop projects.
• Utilize data analysis techniques to detect aberrancies in Medicaid claims data and proactively seek out and develop leads received from a variety of sources (CMS, OIG, State Program Integrity, MFCU, fraud alerts).
• Assist in the review of claims history/provider files to determine provider billing patterns and to detect potential fraudulent or abusive billing practices or vulnerabilities in Medicaid policies and initiate appropriate action.
• Make potential fraud determinations by utilizing internal guidelines, Medicaid provider manuals, Medicaid regulations, and the Social Security Act.
• Identify Fraud alerts and program vulnerabilities for submission to CMS; share information on current fraud investigations with other Medicaid contractors, law enforcement, and other applicable stake holders.
• Track and report Medicaid project progress internally and ad hoc to CMS and the States.
• Coordinate work flow from project to lead stage.
• Continuous communication with other UPICs for potential project development.
• Review and provide support and respond to requests for information from Medicaid stake holders as assigned.
• Telework available from anywhere in the US

Skills

Research skills

Communication

Writing skills

Statistics knowledge

Data analysis

Project coordination

Independent work

Tools

Microsoft Access

Excel

Job description

Basic Qualifications:

• 5 years with BS/BA; or 9 years with a HS Diploma/equivalent
• Healthcare policy and regulation experience (Medicaid preferred).
• Strong research skills.
• Strong communication and organization skills.
• Strong writing skills.
• Strong computer skills including Microsoft Access, experience in relational data base design, extract, and reporting, Excel, and the Internet
• Strong proven analytical ability and basic knowledge of statistics and sampling techniques
• Proven Ability to work with a variety of systems, sources of data and analytic tools
• Excellent organizational and communication skills
• US. citizenship required

The most competitive candidates will have:

• Ability to perform research and draw conclusions.
• Ability to interpret data, policy relative to an allegation.
• Ability to manage several projects at a time while meeting deadlines with a quality work-product.
• Ability to work as a liaison across teams, State Medicaid Agencies and CMS in order to identify high priority projects; prioritize the work; and manage the development of the various components that make up the final work-product.
• Ability to present findings/issues of concern, citing regulatory violations in connection with compliance issues or fraud schemes to defraud State and Federal Government agencies.
• Ability to compose correspondence and reports.
• Ability to communicate effectively, internally and externally.
• Ability to interpret laws and regulations.
• Ability to handle confidential material.
• Ability to report work activity on a timely basis.
• Ability to work independently and as a member of a team to deliver high quality work.
• Ability to attend meetings, training, and conferences.

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 Project Coordinator to our SGS team of talented professionals.

What You’ll do:

The Project Coordinator will play a pivotal role in supporting the Medicaid Managed Care audit initiative by bridging the gap between business needs and technical solutions. This position requires a unique blend of project management expertise, data strategy development, and technical knowledge of methodologies and algorithms to ensure audit-related data is validated, reliable, and actionable.

• Leads projects resulting from the discovery of situations that potentially involve fraud, waste or abuse in Medicaid.
• Develop project methodologies arising out of the project idea including coordinating with internal teams to develop projects.
• Utilize data analysis techniques to detect aberrancies in Medicaid claims data and proactively seek out and develop leads received from a variety of sources (CMS, OIG, State Program Integrity, MFCU, fraud alerts).
• Assist in the review of claims history/provider files to determine provider billing patterns and to detect potential fraudulent or abusive billing practices or vulnerabilities in Medicaid policies and initiate appropriate action.
• Make potential fraud determinations by utilizing internal guidelines, Medicaid provider manuals, Medicaid regulations, and the Social Security Act.
• Identify Fraud alerts and program vulnerabilities for submission to CMS; share information on current fraud investigations with other Medicaid contractors, law enforcement, and other applicable stake holders.
• Track and report Medicaid project progress internally and ad hoc to CMS and the States.
• Coordinate work flow from project to lead stage.
• Continuous communication with other UPICs for potential project development.
• Review and provide support and respond to requests for information from Medicaid stake holders as assigned.
• Telework available from anywhere in the US