Remote Medicare Administrative Action Specialist

Peraton; Idaho, United States, Northern America, Americas; Hybrid; USD 51,000 - 82,000; Full time

Job summary

Peraton is seeking an Admin Action Specialist for SafeGuard Services to support CMS administrative actions related to investigations. You will handle evidence review, action development, and coordination with CMS, MACs, and law enforcement while managing a high-volume workload.

Applicants should have Medicare knowledge, strong communication and organization skills, and the ability to work independently or in a team. Telework is available from the eastern time zone.

Qualifications

• 2 years with BS/BA or 6 years with HS diploma/equivalent.
• Knowledge of Medicare requirements related to payment for services.
• Strong communication and organizational skills.
• Experience reviewing claims, performing medical reviews, and/or developing fraud cases.
• Ability to handle confidential material and report work activity on a timely basis.
• US citizenship required.

Responsibilities

• Act as Point of Contact for CMS for all administrative actions related to investigations.
• Develop and submit an action to CMS for approval.
• Maintain a high-volume workload with quick actions and multiple metrics.
• Review evidence supporting administrative action as it relates to payment suspensions, revocations, and overpayments.
• Coordinate with Investigative Teams, CMS, law enforcement, and MACs throughout the action lifecycle.
• Monitor workload and ensure actions meet Program Integrity Manual timeframes.
• Prepare and submit administrative action packages for CMS approval.
• Telework available from eastern time zone.

Skills

CMS knowledge

Communication

Organization

Data analysis

Investigations

Research skills

Confidential handling

Teamwork

Independent work

Education

BS/BA or HS diploma

US citizenship

Job description

Peraton is seeking an Admin Action Specialist for SafeGuard Services to support CMS administrative actions related to investigations. You will handle evidence review, action development, and coordination with CMS, MACs, and law enforcement while managing a high-volume workload.

Applicants should have Medicare knowledge, strong communication and organization skills, and the ability to work independently or in a team. Telework is available from the eastern time zone.