Remote Admin Action Specialist for CMS Investigations

Peraton; United States; À distance; USD 51 000 - 82 000; Plein temps

Résumé du poste

Peraton, a leading national security company, is seeking an Admin Action Specialist to join SafeGuard Services (SGS). You will liaison with CMS, review evidence, and prepare action packages for pursuit of recovery of fraud, waste, and abuse.

This role requires strong analytical and communication skills, proficiency with Medicare rules, and the ability to manage a high‑volume workload. Telework is available from all time zones, reflecting Peraton's flexible, nationwide team.

Qualifications

• 2 years with BS/BA; 0 years with MS/MA; 6 years with a HS diploma/equivalent
• Knowledge of Medicare requirements, laws, rules and regulations related to payment
• Strong communication and organization skills
• Experience in reviewing claims, performing medical reviews, and/or developing fraud cases
• Strong PC knowledge and skills
• Document QC results in WMM according to record type
• US citizenship required

Responsabilités

• Review and verify evidence supporting administrative action as it relates to payment suspensions, revocations, overpayments as well as other administrative actions that can be pursued (payment suspension, revocation, prepayment edits, auto-denial edits)
• Work with the Investigative Teams to ensure that the documentation gathered is sufficient to support an administrative action
• Work with CMS, law enforcement and the Medicare Administrative Contractor throughout the life of the action
• Monitor workload to ensure all actions are taken within the required timeframes set forth in the Program Integrity Manual
• Prepare and submit administrative action packages to CMS and the MACs for approval and processing and speak to the action development
• Telework available from all time zone

Connaissances

communication

organization

research and analysis

independent work

confidential material handling

regulatory interpretation

Formation

BS/BA or MS/MA or HS diploma

Outils

WMM

UCM

Description du poste

Peraton, a leading national security company, is seeking an Admin Action Specialist to join SafeGuard Services (SGS). You will liaison with CMS, review evidence, and prepare action packages for pursuit of recovery of fraud, waste, and abuse.

This role requires strong analytical and communication skills, proficiency with Medicare rules, and the ability to manage a high‑volume workload. Telework is available from all time zones, reflecting Peraton's flexible, nationwide team.