Medicaid Fraud Auditor

Peraton

5d•$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 a Medicaid Fraud Auditor to our SGS team of talented professionals. Thie Fraud Auditor will conduct high level complex audits and reviews of medical professional service providers to ensure compliance with federal and state program requirements and if determined, recommend recovery of over-payments for non-compliance. The individual applies an intermediate level of subject matter knowledge to solve a variety of common business issues. Works on problems of moderately complex scope. Acts as an informed team member providing analysis of information and project direction input. Exercises independent judgment within defined practices and procedures to determine appropriate action. Follows established guidelines and correctly interpret policies. Evaluates unique circumstances and makes recommendations.

Requirements

2 years with a Bachelor’s degree; or High School diploma with 6 years experience in lieu of a degree.
2+ years of related work experience
Knowledge of internal audit/investigative policies and operating principles.
Strong research, analytical, interpersonal skills.
Strong familiarity with Microsoft Office tools, including intermediate to advanced knowledge of Excel and pivot tables.
US. citizenship required.

Nice To Haves

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

Responsibilities

Provides research, interprets laws and regulations, performs data analysis and draws conclusions for projects.
Uses good judgment conducting compliance audits of varied Medicaid case-types, auditing claim submissions and performing ad-hoc focused audits.
Handles multiple assignments concurrently; organizes and analyzes billing patterns; conducts interviews and obtains statements from beneficiaries/recipients and others.
Develops an understanding of the function to be audited and uses business knowledge, analytical skills, and experience in identifying findings and making recommendations for improvements.
Identifies compliance exceptions, conflicts of interest, improper payments.
Organizes a case file, accurately and thoroughly documents all steps taken.
Works independently or at times as part of a team, provide ongoing progress reports and updates on audit status.
Presents issues of concern verified through data, citing regulatory violations, proving schemes or scams to defraud the Government.
Compose correspondence, reports, and referral summary letters.
Works under general supervision and as a member of a team to deliver high quality work.
Ensure that projects are timely, complete and accurate; and,
Actively participants at meetings and attends training to further his business acumen.