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Peraton
Peraton
Sponsor pentru viza H1BAsistență medicalăConsultanțăLogistică
Peraton este o companie de tehnologie pentru întreprinderi, orientată spre misiuni, care deservește clienți din domeniul securității naționale, al armatei și al administrației publice. Activitatea sa acoperă servicii IT și de securitate cibernetică avansate, inclusiv apărare cibernetică, operațiuni în cloud, inginerie, informații și soluții tehnologice bazate pe date. Peraton reunește echipe numeroase și specializate pentru a aborda provocări operaționale și de securitate complexe, prin roluri care sprijină furnizarea de capabilități tehnologice pentru misiuni critice.
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Medicare Fraud Investigator – Remote

Investigate complex Medicare provider cases for Peraton subsidiary SafeGuard Services. Build referrals, analyze claims and evidence, and support fraud prevention and recovery efforts.

USStatele Unite ale AmericiiCTConnecticutMEMaineMDMarylandMAMassachusettsNHNew HampshireNYNew YorkPAPennsylvaniaRIRhode IslandVTVermontVAVirginia
66.000 $ – 106.000 $ / an
RemoteNormă întreagăNivel mediuSeniorLimbă Obligatorie: englezăGeneralInvestigator de fraude

Descriere

  • Conduct complex investigations of medical professional service providers
  • Prepare cases for law enforcement referrals, provider education, overpayment recovery and other administrative actions
  • Coordinate with internal teams and external agencies on case development and corrective measures
  • Respond to data and investigative support requests
  • Manage multiple caseloads at the same time
  • Organize and assess complex patterns of evidence
  • Interview witnesses and other involved parties and obtain statements
  • Write detailed investigative reports using program requirements, regulations and applicable federal or state law
  • Research relevant offenses and carry out efficient investigations to identify or verify suspected violations
  • Gather information and evidence through observation, record reviews and interviews
  • Evaluate investigative findings, determine whether allegations are substantiated and recommend appropriate action
  • Draft objective, accurate correspondence
  • Protect health privacy information and follow applicable laws, regulations and program rules
  • Train and mentor others in investigative tools and techniques
  • Build proficiency with investigative tools and identify potential fraud schemes
  • Educate providers, provider associations, law enforcement, contractors and beneficiary advocacy groups about program safeguard matters
  • Participate in meetings, training sessions and conferences
  • Testify in court about investigative findings when required

Cerințe

  • At least 5 years of experience with a BS/BA, or 9 years with a high school diploma or equivalent
  • Five to six years of investigative experience
  • Demonstrated investigative ability
  • Strong communication and organizational skills
  • Strong PC knowledge and technical proficiency
  • U.S. citizenship
  • Ability to research information and draw sound conclusions
  • Ability to organize case files and document every step accurately and thoroughly
  • Ability to write correspondence, reports and referral summary letters
  • Ability to interpret laws and regulations
  • Ability to handle confidential information
  • Ability to manage and prioritize work to meet or exceed customer metrics
  • Ability to work independently and collaboratively
  • Willingness and ability to attend meetings, training and conferences, including overnight travel
  • Experience reviewing claims for technical requirements, conducting medical review and/or developing fraud cases
  • Knowledge of investigative practices involving healthcare providers
  • Knowledge of Medicare and/or Medicaid programs and their related 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

Beneficii

  • Overtime eligibility may depend on the position
  • Shift differentials may depend on the position
  • A discretionary bonus may be available depending on the position
  • Overnight travel may be required or available

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