Admin Action Specialist

Peraton•,

3d•$51,000 - $82,000•Remote

About The Position

SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse. We are looking to add an Admin Action Specialist to our SGS team of talented professionals. The Admin Action Specialist is responsible for being a Point of Contact for Investigations team, MAC and CMS regarding all administrative actions related to Medicare investigations. Responsibilities include: Review and verify evidence supporting administrative action as it relates to payment suspensions, revocations, overpayments as well as other Medicare administrative actions that can be pursued. Work with the Investigations, Medical Review and Data teams to ensure that the documentation gathered is sufficient to support administrative action. Making administrative action recommendations to Investigations and CMS. Work with CMS, law enforcement and the Medicare Administrative Contractor throughout the life of the action. Monitor workload to ensure all actions are taken within the required timeframes set forth in the Program Integrity Manual. Prepare and submit administrative action packages to CMS and the MACs for approval and processing and speak to the action development. Ensure that all timelines are followed. Telework available - (must be available during the hours in the eastern time zone)

Requirements

2 years with BS/BA; 0 years with MS/MA; 6 years with High School diploma in lieu of degree
Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed to the Program
Strong communication and organization skills
Experience in reviewing case files and/or developing fraud cases
Strong PC knowledge and skills
Ability to manage a high workload and meet timeframes set forth
Knowledge of Medicare systems
Ability to perform research and draw conclusions
Ability to present issues of concern, citing and interpreting regulatory violations
Ability to organize a case file, accurately and thoroughly document all steps taken
Ability to compose correspondence, reports and letters clearly and concisely.
Ability to communicate effectively, internally and externally
Ability to interpret laws and regulations
Ability to handle confidential material
Ability to report work activity on a timely basis
Ability to work independently and as a member of a team to deliver high quality work
Ability to attend meetings, training, and conferences, overnight travel may be required
U.S. citizenship required

Nice To Haves

Medicare fraud investigation and/or Medicare billing background
Familiar with Unified Program Integrity Contractor (UPIC) requirements and guidelines
Investigations background
CFE or AHFI certification

Responsibilities

Review and verify evidence supporting administrative action as it relates to payment suspensions, revocations, overpayments as well as other Medicare administrative actions that can be pursued.
Work with the Investigations, Medical Review and Data teams to ensure that the documentation gathered is sufficient to support administrative action.
Making administrative action recommendations to Investigations and CMS.
Work with CMS, law enforcement and the Medicare Administrative Contractor throughout the life of the action.
Monitor workload to ensure all actions are taken within the required timeframes set forth in the Program Integrity Manual.
Prepare and submit administrative action packages to CMS and the MACs for approval and processing and speak to the action development.
Ensure that all timelines are followed.