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Fraud Auditor Associate
Investigate suspected healthcare provider fraud for Peraton’s SafeGuard Services by reviewing medical claims, developing cases, and supporting audits, referrals, and overpayment recovery.
संयुक्त राज्य$39,000 – $62,000 / वर्ष
रिमोटपूर्णकालिकजूनियरमध्य स्तरडिग्री आवश्यक नहींआवश्यक भाषा: अंग्रेज़ीलेखा परीक्षकविवरण
- Conduct entry-level fraud investigations and audits with direct supervision from a team manager or lead.
- Investigate medical service providers and prepare cases and reports for law enforcement referrals, education, overpayment recovery, and administrative action.
- Coordinate with internal teams, external agencies, state and federal investigators, and other personnel on cases, audits, and corrective actions.
- Manage several caseloads at once and organize and analyze information.
- Help prepare complex reports that apply rules or regulations to affected programs.
- Research relevant offenses and carry out efficient investigations and audits.
- Identify or verify suspected violations through observation, records review, and interviews.
- Assess investigation and audit findings to determine whether allegations are supported and what corrective steps are appropriate.
- Draft correspondence that is objective and accurate.
- Protect confidential health information and follow applicable laws, rules, and regulations.
- Maintain case files and document investigative and audit work.
- Write correspondence, reports, and referral summary letters.
- Educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups about program safeguards.
- Submit timely reports of work activity.
- Attend meetings and training conferences; overnight travel may be required.
आवश्यकताएँ
- No experience required with a bachelor’s degree, or four years of experience with a high school diploma or equivalent.
- Investigative and analytical experience.
- Strong communication and organizational skills.
- Strong computer skills.
- U.S. citizenship required.
- A background in investigations or compliance audits is preferred for the most competitive candidates.
- Experience reviewing claims for technical requirements, conducting medical reviews, or developing fraud cases and identifying overpayments is preferred for the most competitive candidates.
- Knowledge of investigative or audit practices involving healthcare providers is preferred for the most competitive candidates.
- Knowledge of Medicare or Medicaid programs and their rules, regulations, policies, and procedures is preferred for the most competitive candidates.
- Experience evaluating, reviewing, and analyzing medical claims and records is preferred for the most competitive candidates.
- Ability to learn and use data systems, equipment, and tools used in investigations.
- Ability to research information and draw conclusions.
- Ability to interpret laws and regulations.
- Ability to handle confidential material.
- Ability to work as a team member under direct supervision.
- Ability to attend meetings and training conferences; overnight travel may be required.
लाभ
- Telework is available from the Eastern Time Zone.
- Overtime eligibility may apply.
- Shift differentials may apply.
- A discretionary bonus may apply.
- Equal opportunity employment, including for people with disabilities and protected veterans.
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