Peraton — ұлттық қауіпсіздік, әскери және мемлекеттік ұйымдар саласындағы клиенттерге қызмет көрсететін, миссияға бағытталған корпоративтік технологиялар компаниясы. Оның қызметі киберқорғаныс, бұлтты операциялар, инженерия, барлау және деректерге негізделген технологиялық шешімдерді қоса алғанда, озық IT және киберқызметтерді қамтиды. Peraton күрделі операциялық және қауіпсіздік мәселелерін шешу үшін ауқымды әрі мамандандырылған командаларды біріктіреді. Бұл командалар аса маңызды миссияларға арналған технологиялық мүмкіндіктерді ұсынуға қолдау көрсететін рөлдерде жұмыс істейді.
Fraud Investigator Associate – Healthcare Claims | Peraton Remote
Support Peraton’s healthcare fraud investigations by analyzing medical claims, developing cases, and assisting with recovery and law-enforcement referrals.
Сипаттама
- Investigate medical professional service providers and support complex healthcare fraud cases.
- Prepare cases and reports for law-enforcement referrals, provider education, overpayment recovery, and other administrative actions.
- Assist fraud investigators and auditors with case development, audits, and corrective actions.
- Collaborate with internal teams, external agencies, state and federal investigators, and other personnel.
- Respond to requests for data and investigative support.
- Manage multiple caseload assignments at the same time.
- Organize and analyze information that supports the team’s workload.
- Help prepare complex reports by applying regulations and rules to affected programs.
- Research and understand relevant offenses.
- Conduct efficient investigations and audits into alleged offenses.
- Identify or verify suspected violations through observation, record review, and interviews.
- Analyze investigation and audit findings to determine whether allegations are supported.
- Help identify appropriate actions for addressing confirmed issues.
- Draft objective, accurate correspondence and communicate tactfully.
- Adapt investigative activities and courses of action when unplanned situations arise.
- Protect confidential health information and follow applicable laws, rules, and regulations.
Талаптар
- No experience 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 personal computer knowledge and skills.
- U.S. citizenship required.
- Background in investigations or compliance audits preferred for competitive candidates.
- Experience reviewing claims for technical requirements, conducting medical review, or developing fraud cases and identifying overpayments preferred for competitive candidates.
- Knowledge of investigative or audit practices involving healthcare providers preferred for competitive candidates.
- Knowledge of Medicare or Medicaid programs and their rules, regulations, policies, and procedures preferred for competitive candidates.
- Experience evaluating, reviewing, and analyzing medical claims and records preferred for competitive candidates.
- Ability to learn and use data systems, equipment, and tools for investigations.
- Ability to conduct research and draw conclusions.
- Ability to document investigative or audit workload, present concerns, cite regulatory violations, and allege schemes or scams to defraud the Government.
- Ability to organize case files and accurately document every step taken.
- Ability to write correspondence, reports, and referral summary letters.
- Ability to educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups about program safeguard matters.
- Ability to communicate effectively with internal and external stakeholders.
- Ability to interpret laws and regulations.
- Ability to handle confidential materials.
- Ability to report work activity promptly.
- Ability to work under direct supervision as part of a team delivering high-quality work.
- Ability to attend meetings and training conferences; overnight travel may be required.
Артықшылықтар
- Telework is available from the Eastern Time Zone.
- Overtime may be available.
- Shift differential may be available.
- A discretionary bonus may be available.
- Peraton is an equal opportunity employer, including for people with disabilities and protected veterans, and prohibits discrimination based on other characteristics protected by law.