Medicaid Fraud Auditor

Peraton•,

2d•$51,000 - $82,000•Remote

About The Position

SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigations, and medical reviews to detect, prevent, deter, and reduce fraud, waste, and abuse, and to make referrals for recovery. The Medicaid Fraud Auditor conducts audits and reviews of Medicaid programs to assess compliance with federal and state requirements and recover overpayments arising from non-compliance. The role applies intermediate subject-matter knowledge to business issues of moderately complex scope, analyzes information, and provides limited project-direction input. The auditor exercises independent judgment within defined practices and procedures, interprets policies and guidelines, evaluates unusual circumstances, and makes recommendations. The position works under general supervision, independently or as part of a team, and is responsible for timely, complete, and accurate project work. Telework is available from any state in the United States.

Requirements

At least 2 years of experience with a bachelor's degree, 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.
Strong familiarity with Microsoft Office tools, including intermediate to advanced Excel knowledge.
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 various 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.
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 progress reports and updates on audit status.
Present data-verified concerns, cite regulatory violations, and substantiate schemes or scams to defraud the Government.
Compose correspondence, reports, and referral summary letters.
Deliver high-quality work under general supervision as a member of a team.
Ensure projects are timely, complete, and accurate.
Participate in meetings and attend training to further business acumen.