Remote Medicare Administrative Action Specialist

Peraton; Reston (VA); Remote; USD 51,000 - 82,000; Full time

Job summary

Peraton seeks an Administrative Action Specialist to support SafeGuard Services (SGS) in CMS administrative actions. You will develop and submit actions, verify evidence, and coordinate with CMS, law enforcement, and MACs, handling high-volume workloads with strict timelines.

Strong Medicare knowledge, regulatory interpretation, and documentation skills are required; US citizenship is required. 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, laws and billing rules for services billed to the Program.
• Strong communication and organization skills.
• Experience in reviewing claims, medical reviews, and fraud case development.
• Ability to handle confidential material.
• US citizenship required.

Responsibilities

• Serve as a CMS point of contact for all administrative actions related to investigations.
• Develop and submit actions to CMS for approval.
• Maintain a high-volume workload with quick actions and metrics.
• Review and verify evidence supporting actions related to suspensions and revocations.
• Coordinate with Investigative Teams, CMS, law enforcement, and MACs throughout the action life cycle.
• Monitor timeliness per the Program Integrity Manual.
• Prepare and submit administrative action packages to CMS and MACs for approval.
• Telework available from eastern time zone.

Skills

Medicare knowledge

Regulatory interpretation

Communication

Organization

Claims review

Medical review

Documentation

Confidential handling

Research ability

Independent work

Team collaboration

Education

BS/BA required or 2 years post-secondary with experience

HS diploma with 6 years experience

Tools

WMM

CMS system

Job description

Peraton seeks an Administrative Action Specialist to support SafeGuard Services (SGS) in CMS administrative actions. You will develop and submit actions, verify evidence, and coordinate with CMS, law enforcement, and MACs, handling high-volume workloads with strict timelines.

Strong Medicare knowledge, regulatory interpretation, and documentation skills are required; US citizenship is required. Telework is available from the eastern time zone.