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Medicare Fraud Investigator — Remote in South Carolina | Peraton
Peraton is hiring a remote Medicare Fraud Investigator in South Carolina to examine provider claims and develop healthcare fraud cases. The role involves complex investigations, evidence analysis, interviews, reporting, and referrals.
संयुक्त राज्य
दक्षिण कैरोलाइना$66,000 – $1,06,000 / वर्ष
रिमोटपूर्णकालिकमध्य स्तरवरिष्ठआवश्यक भाषा: अंग्रेज़ीधोखाधड़ी अन्वेषकसामान्यविवरण
- Investigate complex cases involving medical professional service providers
- Develop referrals for law enforcement, provider education, overpayment recovery, and other administrative actions
- Coordinate with internal teams and external agencies to build cases and implement corrective actions
- Respond to data and investigative support requests
- Manage multiple caseloads simultaneously
- Organize and evaluate complex patterns of evidence
- Interview witnesses and other individuals and obtain formal statements
- Prepare complex investigative reports based on applicable program regulations and rules
- Apply relevant federal and state laws to investigative work
- Research applicable offenses and understand their implications
- Investigate alleged offenses and identify or confirm suspected violations
- Gather information and evidence through observation, record review, and interviews
- Evaluate investigative findings to determine whether allegations are substantiated
- Collaborate with others to determine appropriate responses to identified issues
- Draft correspondence and communicate findings objectively, accurately, and tactfully
- Protect health privacy information and comply with applicable laws, regulations, and rules
- Testify in court about investigative findings when required
- Provide program safeguard education to providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups
आवश्यकताएँ
- Five years of experience with a bachelor’s degree, or nine years of experience with a high school diploma
- Professional investigative experience
- Strong investigative capabilities
- Strong communication and organizational skills
- Strong proficiency with personal computers
- U.S. citizenship
- Experience reviewing claims for technical compliance, conducting medical reviews, or developing fraud cases
- Knowledge of investigative methods involving healthcare providers
- Knowledge of Medicare programs and their rules, regulations, policies, and procedures
- Experience evaluating, reviewing, and analyzing medical claims and records
- Ability to learn and use the data systems, equipment, and tools required for investigations
- Ability to conduct research and draw sound conclusions
- Ability to present concerns by identifying regulatory violations and alleged schemes or scams targeting the government
- Ability to organize case files and document every investigative step accurately and completely
- Ability to write correspondence, reports, and referral summary letters
- Ability to educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups about program safeguards
- Effective internal and external communication skills
- Ability to interpret laws and regulations
- Ability to handle confidential information
- Ability to report work activity on schedule
- Ability to work independently and collaboratively
- Availability for meetings, training, and conferences
- Availability for overnight travel
लाभ
- Telework is available from the Atlanta, Georgia area or South Carolina
- Additional compensation may include overtime, shift differentials, and a discretionary bonus beyond base pay
- Peraton is an equal opportunity employer, including for individuals with disabilities, protected veterans, and others protected by law