Peraton yra į misiją orientuota technologijų įmonė, teikianti paslaugas nacionalinio saugumo, kariuomenės ir vyriausybinėms institucijoms. Jos veikla apima pažangias IT ir kibernetinio saugumo paslaugas, įskaitant kibernetinę gynybą, debesijos operacijas, inžineriją, žvalgybą ir duomenimis grindžiamus technologinius sprendimus. Peraton telkia dideles specializuotas komandas, kad spręstų sudėtingus veiklos ir saugumo iššūkius, o įmonės pareigybės padeda diegti technologinius pajėgumus, reikalingus kritinėms misijoms.
Remote Healthcare Fraud Investigator at Peraton
Investigate suspected fraud, waste, and abuse involving healthcare providers in Peraton’s government programs. Analyze claims, build cases, and support referrals, recoveries, and corrective actions.
Aprašymas
- Conduct complex investigations of medical service providers.
- Build cases for law enforcement referrals, provider education, overpayment recovery, and other administrative actions.
- Coordinate with internal teams, external agencies, and state and federal investigators to develop cases and corrective actions.
- Respond to requests for data and investigative support.
- Manage multiple caseloads at the same time.
- Organize and assess complex evidence patterns.
- Interview witnesses and other parties, and collect statements.
- Prepare detailed investigative reports using applicable regulations, rules, and federal or state laws.
- Research relevant offenses and investigate alleged violations.
- Gather information and evidence through observation, records review, and interviews.
- Assess findings to determine whether allegations are supported by evidence.
- Identify appropriate actions to address issues uncovered.
- Draft correspondence and case referral summaries.
- Handle health privacy information objectively, accurately, tactfully, and confidentially.
- Educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups about program safeguards.
- Attend meetings, training sessions, and conferences, with overnight travel as required.
- Testify in court about investigative findings when required.
Reikalavimai
- At least 2 years of experience with a bachelor’s degree, or 6 years with a high school diploma or equivalent.
- Knowledge of Medicare and/or Medicaid programs, including their rules, regulations, policies, and procedures.
- Healthcare industry knowledge and experience.
- Strong investigative skills.
- Strong communication and organizational skills.
- Strong computer skills.
- U.S. citizenship required.
- Ability to conduct research and draw conclusions.
- Ability to organize case files and accurately document all actions taken.
- Ability to interpret laws and regulations.
- Ability to handle confidential information.
- Ability to manage and prioritize workload effectively.
- Ability to work independently and as part of a team.
- Ability to attend meetings, training sessions, and conferences, and travel overnight as required.
- Substantial investigative experience.
- Experience reviewing claims for technical requirements, conducting medical reviews, and/or developing fraud cases.
- Knowledge of investigative practices involving healthcare providers.
- Experience evaluating, reviewing, and analyzing medical claims and records.
- Ability to learn and use data systems, equipment, and tools used in investigations.
Privalumai
- Telework is available from specified states and the District of Columbia.
- Overtime eligibility may be available.
- Shift differential may be available.
- A discretionary bonus may be available.