Medicaid Auditor/Investigator

Peraton•,

4d•$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, and reduce fraud, waste, and abuse, and to make 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 resulting from non-compliance. The role applies intermediate subject-matter knowledge to common business issues and moderately complex problems, exercises independent judgment within established procedures, interprets policies, evaluates unique circumstances, and makes recommendations. The position works under general supervision, independently or as part of a team, and is remote for candidates residing in the specified Northeast jurisdiction: Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, Pennsylvania, New Jersey, Delaware, Maryland, the District of Columbia, or Virginia.

Requirements

At least 2 years of experience with a BS/BA, or 6 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.
Must reside within the Northeast jurisdiction listed in the job description.

Nice To Haves

Intermediate financial and business acumen.
Intermediate audit/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 various Medicaid case types, audit claim submissions, and perform focused ad-hoc audits.
Manage concurrent assignments; organize and analyze billing patterns; interview beneficiaries or recipients and other individuals; and obtain statements.
Develop an understanding of the function being audited and apply 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 and thoroughly document all steps taken.
Work independently or as part of a team, providing ongoing progress reports and audit-status updates.
Present data-verified concerns, cite regulatory violations, and document schemes or scams to defraud the Government.
Compose correspondence, reports, and referral summary letters.
Deliver timely, complete, and accurate project work.
Participate in meetings and attend training to further business acumen.