Remote Investigations & Administrative Action Lead

Peraton; Idaho; Hybrid; USD 51,000 - 82,000; Full time

Job summary

Peraton is seeking an Admin Action Specialist to join SafeGuard Services (SGS). The role focuses on acting as the CMS liaison for administrative actions related to investigations, developing actions for approval, and maintaining a fast-paced workload with strict timeframes.

Telework is available from the eastern time zone. The position requires knowledge of Medicare requirements, experience with claims reviews or fraud cases, and strong organizational and communication skills.

Qualifications

• Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed to the Program.
• Experience in reviewing claims, performing medical reviews, and/or developing fraud cases.
• Ability to organize a case file and document all steps thoroughly.

Responsibilities

• Serve as Point of Contact for CMS regarding administrative actions.
• Develop and submit actions for CMS approval.
• Manage high-volume workload with quick actions and multiple metrics.
• Review evidence supporting admin actions related to payments, suspensions, revocations, and prepayment edits.
• Coordinate with Investigative Teams and CMS, law enforcement, and MAC during actions.
• Ensure actions are completed within set timeframes per the Program Integrity Manual.
• Prepare and submit action packages to CMS and MACs for approval.

Skills

Strong communication

Organizational skills

Research & analysis

Independent worker

Confidential materials handling

Team collaboration

Education

BS/BA

HS diploma/equivalent

Tools

WMM

UCM

Microsoft Office

Job description

Peraton is seeking an Admin Action Specialist to join SafeGuard Services (SGS). The role focuses on acting as the CMS liaison for administrative actions related to investigations, developing actions for approval, and maintaining a fast-paced workload with strict timeframes.

Telework is available from the eastern time zone. The position requires knowledge of Medicare requirements, experience with claims reviews or fraud cases, and strong organizational and communication skills.