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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.

USAmerika Qo‘shma ShtatlariCTKonnektikutMEMenMDMerilendMAMassachusetsNHNyu-HempshirNYNyu-YorkPAPensilvaniyaRIRod-AylendVTVermontVAVirjiniya
66 000 $ – 106 000 $ / yil
MasofaviyTo‘liq stavkaO‘rta darajaSeniorTalab Qilinadigan Til: inglizchaFiribgarlik tergovchisiUmumiy

Tavsif

  • 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

Talablar

  • 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

Imtiyozlar

  • 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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