Fraud Auditor Associate

Peraton•,

1d•$39,000 - $62,000

About The Position

SafeGuard Services (SGS), a subsidiary of Peraton, conducts data analysis, investigations, and medical reviews to detect, prevent, deter, and reduce fraud, waste, and abuse, and to make referrals for recovery. The Fraud Auditor Associate is an entry-level fraud investigator/auditor who works under the direct supervision of a team manager and/or team lead. The position supports a team conducting complex investigations of medical professional service providers and developing cases and reports for potential law enforcement referrals, provider education, overpayment recovery, and other administrative actions. The associate supports investigations and audits in collaboration with internal resources, external agencies, state and/or federal investigators, and other personnel. Responsibilities include managing concurrent caseload assignments; organizing and analyzing information; researching alleged offenses; gathering information and evidence through observation, record examination, and interviews; and helping assess findings and determine appropriate corrective actions. The role may also involve assisting with complex reports that apply program rules and regulations to reviewed conduct. The associate prepares correspondence and reports, communicates objectively and tactfully, and maintains confidentiality while handling health privacy information. The role requires flexibility to respond to unplanned situations and an understanding of the laws, rules, and regulations concerning health privacy. Meetings, training conferences, and overnight travel may be required.

Requirements

A bachelor’s degree (BS/BA) with no years of experience, or a high school diploma/equivalent with four years of experience.
Investigative and analytical experience.
Strong communication and organization skills.
Strong PC knowledge and skills.
U.S. citizenship.
Ability to perform research and draw conclusions.
Ability to document investigative or audit work, organize case files, and accurately record steps taken.
Ability to compose correspondence, reports, and referral summary letters.
Ability to communicate effectively, interpret laws and regulations, and handle confidential material.
Ability to report work activity on time and work under direct supervision as a team member.
Ability to attend meetings and training conferences; overnight travel may be required.

Nice To Haves

Strong background in investigations or compliance audits.
Experience reviewing claims for technical requirements, performing medical review, and/or developing fraud cases and identifying overpayments.
Knowledge of investigative or audit practices regarding healthcare providers.
Knowledge of Medicare and/or Medicaid programs and their rules, regulations, policies, and procedures.
Background evaluating, reviewing, and analyzing medical claims and records.
Ability to learn and operate data systems, equipment, and tools used in investigations.

Responsibilities

Support fraud investigators and auditors conducting investigations and audits of medical professional service providers.
Work with internal resources, external agencies, and state and/or federal investigators to develop cases, audits, and corrective actions, and respond to requests for data and support.
Handle multiple caseload assignments concurrently and organize and analyze information in support of the team’s workload.
Assist with complex reports applying relevant rules or regulations to the programs affected by reviewed behavior.
Research and understand relevant alleged offenses and participate in efficient and effective investigations or audits to detect or verify suspected violations.
Obtain information and evidence through observation, record examination, and interviews.
Collaborate with team members to analyze investigation or audit results, assess whether allegations are corroborated, and determine appropriate steps to address issues.
Prepare correspondence and communicate objectively, accurately, and tactfully.
Maintain confidentiality and understand laws, rules, and regulations concerning health privacy.
Conduct research and draw conclusions; document investigative and audit work, present issues of concern, and cite regulatory violations or alleged schemes to defraud the Government.
Organize case files and accurately document all steps taken.
Compose correspondence, reports, and referral summary letters.
Educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters.
Interpret laws and regulations, communicate effectively internally and externally, and handle confidential material.
Report work activity on a timely basis and work under direct supervision as part of a team to deliver high-quality work.
Attend meetings and training conferences; overnight travel may be required.

Benefits

Medical, dental, and vision benefits.
Life insurance.
Health savings account.
Short- and long-term disability.
Employee assistance program (EAP).
Parental leave.
401(k).
Paid time off (PTO) for vacation.
Company-paid holidays.
Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.