Fraud Investigator (Administrative Actions) - Medicare

Administrative Action Specialist

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 an Administrative Action Specialist to our SGS team of talented professionals.

What you'll do :

The Administrative Action Specialist is responsible for being a Point of Contact for CMS regarding all administrative actions related to investigations. Providing training and mentoring. Maintaining statistics on all submitted administrative actions. Maintaining template documents used to submit and process administrative actions.

Responsibilities include :

• Review and verify evidence supporting an administrative action as it relates to payment suspensions, revocations, overpayments as well as other administrative actions that can be pursued.
• Work with the Investigative Teams to ensure that the documentation gathered is sufficient to support an administrative action.
• Work with CMS, law enforcement and the Medicare Administrative Contractor throughout the life of the action.
• Monitor workload to ensure all actions are taken within the required timeframes set forth in the Program Integrity Manual.
• Prepare and submit administrative action packages to CMS and the MACs for approval and processing and speak to the action development.
• Telework available from contiguous United States

Basic Qualifications :

Desirable Qualifications :

Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world's leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains : land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can't be done by solving the most daunting challenges facing our customers. Visit peraton.com to learn how we're keeping people around the world safe and secure.

Target Salary Range : $66,000 - $106,000. This represents the typical salary range for this position based on experience and other factors.

EEO : Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.