[Hiring] Admin Action Specialist @Peraton

Role Description

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.

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

• Developing and submitting an action to CMS for approval.
• Maintaining a high-volume workload that requires quick actions and multiple metrics.
• Reviewing and verifying evidence supporting administrative action related to:
• Payment suspensions
• Revocations
• Overpayments
• Other administrative actions (payment suspension, revocation, prepayment edits, auto-denial edits)
• Working with Investigative Teams to ensure sufficient documentation is gathered to support an administrative action.
• Collaborating with CMS, law enforcement, and the Medicare Administrative Contractor throughout the life of the action.
• Monitoring workload to ensure all actions are taken within required timeframes set forth in the Program Integrity Manual.
• Preparing and submitting administrative action packages to CMS and the MACs for approval and processing.

Telework available from all time zones.

Qualifications

• 2 years with BS/BA; 0 years with MS/MA; 6 years with a HS diploma/equivalent.
• 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 claims, performing medical reviews, and/or developing fraud cases.
• Strong PC knowledge and skills.
• Ability to assist team members with workflow development.
• Ability to monitor the quality of WMM/UCM.
• Ability to monitor timeliness for case updates and escalate to management as necessary.
• Ability to monitor the progress of investigations and cases to ensure use of all available remedies (e.g., suspension, pre-pay reviews, revocation).
• Ability to perform research and draw conclusions.
• Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government.
• Ability to organize a case file and accurately document all steps taken.
• Ability to compose correspondence, reports, and referral summary letters.
• Ability to educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters.
• 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.
• Document QC results in WMM according to record type.
• U.S. citizenship required.

Requirements

• CFE or AHFI certification (desired).
• Medicare claims processing experience (desired).

Benefits

• Salary Range: $51,000 - $82,000.
• Salary determined by various factors including scope and responsibilities, individual experience, education, knowledge, skills, and geographic location.
• Eligibility for overtime, shift differential, and discretionary bonus in addition to base pay.

Company Description

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.