[Hiring] Admin Action Specialist @Peraton

Role Description

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

• Providing training and mentoring.
• Maintaining statistics on all submitted administrative actions.
• Maintaining template documents used to submit and process administrative actions.
• Reviewing and verifying evidence supporting an administrative action related to payment suspensions, revocations, overpayments, and other administrative actions.
• Working with the Investigative Teams to ensure that the documentation gathered is sufficient 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 the required timeframes set forth in the Program Integrity Manual.
• Preparing and submitting administrative action packages to CMS and the MACs for approval and processing.
• Documenting QC results in WMM according to record type.
• Assisting team members with workflow development.
• Reviewing individual workload during monthly meetings; assisting with prioritization and conducting QC for staff.
• Monitoring the quality of WMM/UCM.
• Monitoring timeliness for case updates and escalating to management as necessary.
• Monitoring the progress of investigations and cases to ensure use of all available remedies (e.g., suspension, pre-pay reviews, revocation).
• Mentoring team members to identify previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development.
• Telework available from contiguous United States.

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 review, and/or developing fraud cases.
• Strong PC knowledge and skills.
• Ability to attend meetings, training, and conferences; overnight travel may be required.
• U.S. citizenship required.

Requirements

• CFE or AHFI certification.
• 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.

Benefits

• Medical, dental, and vision insurance.
• Life insurance.
• Health savings account.
• Short/long term disability.
• Employee Assistance Program (EAP).
• Parental leave.
• 401(k) plan.
• Paid time off (PTO) for vacation.
• Company paid holidays.