Remote Medicaid Fraud Audit Team Lead

Peraton; Northern (KY); Hybrid; USD 66,000 - 106,000; Full time

Job summary

SafeGuard Services (SGS), a Peraton subsidiary, is seeking a Medicaid Fraud Auditor Team Lead to join our audits, investigations, data analysis, and medical reviews teams. This is a remote position; candidates must reside within the Northeast Jurisdiction (ME, VT, NH, MA, RI, CT, NY, PA, NJ, DE, MD, DC).

You will oversee audit development from initiation through completion, provide day-to-day oversight to auditors, mentor staff, ensure compliance with federal and state Medicaid requirements, and

Qualifications

• Minimum of 8 years with BS/BA; or 12 years with a HS Diploma/equivalent.
• Experience conducting Medicaid, Medicare, healthcare audits.
• Experience leading staff in identifying and documenting noncompliance, improper payments, billing irregularities, or potential overpayments.
• Strong written, verbal communication and organization skills.
• US Citizen.

Responsibilities

• Oversee development and progression of audits from initiation through completion, including planning, audit testing, analysis, findings, provider communications, and issuance of final finding reports.
• Provide day-to-day oversight and direction for assigned Auditors conducting Medicaid audits; ensure audits comply with federal/state requirements and methodologies.
• Provide technical guidance on Medicaid requirements, audit methodology, regulatory interpretation, claims analysis, and findings development.
• Review workload, assist with prioritization, and conduct QC for staff.
• Mentor team members to identify fraud, waste, or abuse through proactive or reactive research.

Skills

Medicaid audits

Team leadership

Regulatory knowledge

Communication

Documentation

PC skills

Education

BS/BA

HS Diploma/equivalent

Tools

Microsoft Office

Job description

SafeGuard Services (SGS), a Peraton subsidiary, is seeking a Medicaid Fraud Auditor Team Lead to join our audits, investigations, data analysis, and medical reviews teams. This is a remote position; candidates must reside within the Northeast Jurisdiction (ME, VT, NH, MA, RI, CT, NY, PA, NJ, DE, MD, DC).

You will oversee audit development from initiation through completion, provide day-to-day oversight to auditors, mentor staff, ensure compliance with federal and state Medicaid requirements, and