Medicaid Fraud Auditor

Peraton•,

22h•$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. This individual will conduct audits and reviews of various Medicaid programs to ensure compliance with federal and state Medicaid program requirements and to recover over-payments for non-compliance. The individual applies 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 limited project direction input. Exercises independent judgment within defined practices and procedures to determine appropriate action. Follows established guidelines and correctly interprets policies. Evaluates unique circumstances and makes recommendations. This is a remote position, candidates must reside within the Northeast Jurisdiction which include the states of Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, Pennsylvania, New Jersey, Delaware, Maryland, District of Columbia, and Virginia.

Requirements

2 years with BS/BA or 6 years with a HS diploma.
Experience in accounting or closely related business field, law enforcement, health science or related field.
Knowledge of internal audit/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 knowledge of Excel.
Must be a US Citizen

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 health care claims data is preferred

Responsibilities

Provides research, interprets laws and regulations, performs data analysis and draws conclusions for projects
Conducts compliance audits of varied Medicaid case-types, audits claim submissions and performs ad-hoc focused audits
Handle several 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, provides 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 delivering high-quality work
Ensures that projects are timely, complete and accurate
Actively participants at meetings and attends training to further his business acumen