Remote Medicaid Fraud Audit Team Lead

Peraton; Reston (VA); Remote; USD 66,000 - 106,000; Full time

Job summary

SafeGuard Services (SGS), a Peraton subsidiary, seeks a Medicaid Fraud Auditor Team Lead to oversee audit programs within the Northeast remote region. This role requires guiding auditors, ensuring adherence to Medicaid requirements, and mentoring staff while maintaining timely, high-quality findings.

The position emphasizes independent judgment within established policies, with travel to meetings when required and strong collaboration with the management team. US citizenship is required.

Qualifications

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

Responsibilities

• Oversee the 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. The Team Lead is responsible for ensuring that audits are appropriately planned, progressed, documented, reviewed, and completed in accordance with applicable federal and state Medicaid requirements, established audit methodologies.
• Provide technical guidance and consultation to Auditors regarding Medicaid requirements, audit methodology, regulatory interpretation, claims analysis, documentation, and development of findings.
• Review individual workload during monthly auditor meetings; assist with prioritizing and conduct QC for staff.
• Establish priorities and monitor staff workloads to ensure resources are appropriately aligned with audit requirements and metrics.
• Monitor the quality of WMM/UCM.
• Monitor timeliness for audit updates and elevate to management as necessary.
• Mentor team members so that they can identify previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development.
• Act as a point of contact for manager.

Skills

Audit leadership

Medicaid/Medicare knowledge

Regulatory interpretation

Data analysis

Communication skills

Team mentoring

Education

BS/BA in relevant field

HS Diploma/equivalent with 12 years experience

Tools

Microsoft Office

Job description

SafeGuard Services (SGS), a Peraton subsidiary, seeks a Medicaid Fraud Auditor Team Lead to oversee audit programs within the Northeast remote region. This role requires guiding auditors, ensuring adherence to Medicaid requirements, and mentoring staff while maintaining timely, high-quality findings.

The position emphasizes independent judgment within established policies, with travel to meetings when required and strong collaboration with the management team. US citizenship is required.