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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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Locurile de muncă ale companiei

Senior Associate Fraud Investigator

Investigate healthcare provider fraud for Peraton’s government program integrity services, examining claims and medical records. Develop cases involving fraud, waste, abuse, and regulatory violations.

USStatele Unite ale AmericiiCTConnecticutMEMaineMDMarylandMAMassachusettsNHNew HampshireNYNew YorkPAPennsylvaniaRIRhode IslandVTVermontVAVirginia
51.000 $ – 82.000 $ / an
RemoteNormă întreagăSeniorLimbă Obligatorie: englezăAsociatGeneral
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Descriere

  • Conduct complex investigations into medical professional service providers.
  • Build cases for law enforcement referrals, education, overpayment recovery, and other administrative actions.
  • Coordinate with internal teams and external agencies to develop cases and corrective actions.
  • Respond to requests for data and investigative support.
  • Manage multiple investigation caseloads at the same time.
  • Organize and assess complex patterns of evidence.
  • Interview witnesses and other individuals and collect statements.
  • Prepare investigative reports that apply relevant regulations, rules, and federal and state laws.
  • Research relevant offenses and investigate suspected violations.
  • Gather information and evidence through observation, record review, and interviews.
  • Assess investigation findings to determine whether allegations are supported.
  • Work with others to identify appropriate corrective actions.
  • Prepare accurate, objective correspondence and communicate with tact.
  • Adapt investigative plans and actions when unexpected situations arise.
  • Protect confidential health information and follow applicable privacy laws, rules, and regulations.
  • Educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups about program safeguards.
  • May appear in court to testify about investigative findings.

Cerințe

  • At least 2 years of experience with a bachelor’s degree, or 6 years of experience 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 PC knowledge and skills.
  • U.S. citizenship required.
  • Preferred: experience reviewing claims for technical requirements, conducting medical reviews, and/or developing fraud cases.
  • Preferred: knowledge of investigative practices involving healthcare providers.
  • Preferred: experience evaluating, reviewing, and analyzing medical claims and records.
  • Ability to learn and use various data systems, equipment, and tools for investigations.
  • Ability to conduct research and draw conclusions.
  • Ability to organize case files and accurately document all actions taken.
  • Ability to present concerns and cite regulatory violations or alleged schemes.
  • Ability to write correspondence, reports, and referral summary letters.
  • Ability to communicate effectively with internal and external parties.
  • Ability to interpret laws and regulations.
  • Ability to handle confidential information.
  • Ability to manage and prioritize workload effectively.
  • Ability to educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups about program safeguards.
  • Ability to work independently and as part of a team.
  • Ability to attend meetings, training sessions, and conferences; overnight travel is required.
  • May be required to appear in court and testify about work findings.

Beneficii

  • Telework is available from eligible locations.
  • Overtime may be available.
  • Shift differential may be available.
  • Discretionary bonus may be available.

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