Medicaid Auditor/Investigator

Peraton•,

21d•$51,000 - $82,000•Remote

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 support referrals for recovery. The Medicaid Auditor/Investigator conducts audits and reviews of Medicaid programs to assess compliance with federal and state requirements and recover overpayments. The role applies intermediate subject-matter knowledge to moderately complex work, exercises independent judgment within established procedures, interprets policies, evaluates individual circumstances, and makes recommendations. This is a remote position.

Requirements

Two years of experience with a bachelor's degree, or six years of experience with a high school diploma.
Experience in accounting or a closely related business field, law enforcement, health science, or a related field.
Knowledge of internal audit or investigative policies and operating principles.
Understanding of Medicare/Medicaid or healthcare auditing.
Strong research and analytical skills.
Intermediate to advanced familiarity with Microsoft Office tools, including Excel.
Must be a U.S. citizen.

Nice To Haves

Intermediate financial and business acumen.
Intermediate audit or investigative skills.
Project management skills.
Knowledge of the healthcare industry and medical coding concepts and/or experience analyzing healthcare claims data.

Responsibilities

Research and interpret laws and regulations, analyze data, and draw conclusions for projects.
Conduct compliance audits of varied Medicaid case types, audit claim submissions, and perform focused ad hoc audits.
Manage concurrent assignments; organize and analyze billing patterns; conduct interviews; and obtain statements from beneficiaries, recipients, and others.
Understand the function being audited and use business knowledge, analytical skills, and experience to identify findings and recommend improvements.
Identify compliance exceptions, conflicts of interest, and improper payments.
Organize case files and accurately document all steps taken.
Work independently or as part of a team, providing progress reports and updates on audit status.
Present data-verified concerns, cite regulatory violations, and establish evidence of schemes or scams to defraud the Government.
Compose correspondence, reports, and referral summary letters.
Deliver high-quality work under general supervision and ensure projects are timely, complete, and accurate.
Participate actively in meetings and attend training to further business acumen.

Benefits

Medical benefits
Dental benefits
Vision benefits
Life insurance
Health savings account
Short- and long-term disability
Employee assistance program (EAP)
Parental leave
401(k)
Paid time off for vacation
Company-paid holidays
Employees may be eligible for overtime, shift differential, and a discretionary bonus, depending on the position.