Remote Nurse Fraud Investigator

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

Job summary

Peraton seeks a Nurse Reviewer to join SafeGuard Services. The role involves conducting medical record reviews, applying clinical judgment to claim payments, and supporting fraud investigations with diverse data sources.

The position emphasizes regulatory research, accurate documentation, and collaboration with external agencies. Telework is available from anywhere in the United States, with potential court testimony as needed.

Qualifications

• 5 years with BS/BA; 3 years with MS/MA; 0 years with PhD.
• Current nursing license is required.
• Strong investigative, communication and organizational skills.

Responsibilities

• Conduct medical record reviews and apply clinical judgment to claim payments.
• Research regulations and cite violations in Medicare payments.
• Review claims data and develop cases for potential fraud investigations.
• Make claim payment decisions based on clinical knowledge.
• Engage with external agencies to develop cases and provide data as needed.
• Attend meetings or trainings; may be required to travel.

Skills

Nursing experience

Investigative skills

Communication skills

Computer skills

US citizenship

Education

BS/BA in Nursing

MS/MA in Nursing

Nursing license

Tools

EHR systems

Medical claims review software

Job description

Peraton seeks a Nurse Reviewer to join SafeGuard Services. The role involves conducting medical record reviews, applying clinical judgment to claim payments, and supporting fraud investigations with diverse data sources.

The position emphasizes regulatory research, accurate documentation, and collaboration with external agencies. Telework is available from anywhere in the United States, with potential court testimony as needed.