Administrative Action Specialist Team Lead

Peraton•,

4d•$66,000 - $106,000•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 Team Lead to our SGS team of talented professionals. As an Administrative Action Lead, this individual’s primary responsibilities include achieving quality objectives, workload oversight to promote timely development and resolution of multiple administrative actions within an investigation. Provide mentoring and guidance to the administrative action team as well as guidance to the investigation teams on what is needed to pursue an action. The individual exercises significant independent judgment within broadly defined policies and practices to determine the best method for accomplishing work and achieving objectives.

Requirements

Minimum of 8 years with BS/BA or 12 years of experience and a HS Diploma.
8 years of relevant investigative experience required
Knowledge of Medicare requirements, laws, rules and regulations related to payment of services billed to the Program
Medicare claims processing knowledge
Strong communication and organization skills
Strong PC knowledge and skills
US citizenship required

Nice To Haves

Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed to the Program
Experience in reviewing claims, performing medical reviews, and/or developing fraud cases
CFE or AHFI certification a plus

Responsibilities

Act as a point of contact for manager
Work with CMS on proceeding with and finalizing administrative actions.
Assist team members with workflow and admin action development.
Review individual workloads during workload meetings; assist with prioritizing and conduct QC for staff.
Monitor the quality of WMM/UCM
Monitor timeliness for case updates and escalating to management as necessary.
Monitor the progress of the administrative action to ensure all timeframes and metrics are met.
Mentor team members so that they can proceed efficiently through the development of an action.
Partake in Investigation requested meetings to discuss admin actions.
Partake in CMS’ high-priority projects and provide direction to the team.
Develop an efficient workflow process and evaluate effectiveness
Ability to perform research and draw conclusions
Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
Ability to organize a case file, accurately and thoroughly document all steps taken
Ability to compose correspondence, reports
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 for the team
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
Document QC results in WMM according to record type
Coordinate with other designated leads, if necessary, for coverage for periods where the lead is out of the office during work hours.