Admin Action Specialist

Responsibilities

SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.

We are looking to add an Admin Action Specialist to our SGS team of talented professionals.

 

What you'll do:

The Admin Action Specialist is responsible for being a Point of Contact for Investigations team, MAC and CMS regarding all administrative actions related to Medicare investigations. Responsibilities include:

 

• Review and verify evidence supporting administrative action as it relates to payment suspensions, revocations, overpayments as well as other Medicare administrative actions that can be pursued.
• Work with the Investigations, Medical Review and Data teams to ensure that the documentation gathered is sufficient to support administrative action. 
• Making administrative action recommendations to Investigations and CMS.
• Work with CMS, law enforcement and the Medicare Administrative Contractor throughout the life of the action.
• Monitor workload to ensure all actions are taken within the required timeframes set forth in the Program Integrity Manual.
• Prepare and submit administrative action packages to CMS and the MACs for approval and processing and speak to the action development.
• Ensure that all timelines are followed
• Telework available - (must be available during the hours in the eastern time zone)

Qualifications

 

Basic Qualifications:

• 2 years with BS/BA; 0 years with MS/MA; 6 years with High School diploma in lieu of degree
• Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed to the Program
• Strong communication and organization skills
• Experience in reviewing case files and/or developing fraud cases
• Strong PC knowledge and skills
• Ability to manage a high workload and meet timeframes set forth
• Knowledge of Medicare systems
• Ability to perform research and draw conclusions
• Ability to present issues of concern, citing and interpreting regulatory violations
• Ability to organize a case file, accurately and thoroughly document all steps taken
• Ability to compose correspondence, reports and letters clearly and concisely.
• Ability to communicate effectively, internally and externally
• Ability to interpret laws and regulations
• Ability to handle confidential material
• Ability to report work activity on a timely basis
• Ability to work independently and as a member of a team to deliver high quality work
• Ability to attend meetings, training, and conferences, overnight travel may be required
• US. citizenship required
• Telework available - (must be available during the hours in the eastern time zone)

 The most competitive candidates will have:

• Medicare fraud investigation and/or Medicare billing background
• Familiar with Unified Program Integrity Contractor (UPIC) requirements and guidelines
• Investigations background
• CFE or AHFI certification

 

Peraton Overview

Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world’s leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can’t be done by solving the most daunting challenges facing our customers. Visit peraton.com to learn how we’re keeping people around the world safe and secure.

Target Salary Range

$51,000 - $82,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual’s experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.

EEO

EEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.