[Hiring] Administrative Action Specialist Team Lead @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 Team Lead to our SGS team of talented professionals.

As an Administrative Action Lead, this individual’s primary responsibilities include:

• Achieving quality objectives and workload oversight to promote timely development and resolution of multiple administrative actions within an investigation.
• Providing mentoring and guidance to the administrative action team.
• Guiding investigation teams on what is needed to pursue an action.
• Exercising significant independent judgment within broadly defined policies and practices.

What You’ll do:

• Act as a point of contact for manager.
• Work with CMS on proceeding with and finalizing administrative actions.
• Assist team members with workflow and admin action development.
• Review individual workloads during workload meetings; assist with prioritizing and conduct QC for staff.
• Monitor the quality of WMM/UCM.
• Monitor timeliness for case updates and escalate to management as necessary.
• Monitor the progress of the administrative action to ensure all timeframes and metrics are met.
• Mentor team members for efficient development of an action.
• Partake in Investigation requested meetings to discuss admin actions.
• Participate in CMS’ high-priority projects and provide direction to the team.
• Develop an efficient workflow process and evaluate effectiveness.
• Telework available from East Coast.

Qualifications

• Minimum of 8 years with BS/BA or 12 years of experience and a HS Diploma.
• 8 years of relevant investigative experience required.
• Knowledge of Medicare requirements, laws, rules, and regulations related to payment of services billed to the Program.
• Medicare claims processing knowledge.
• Strong communication and organization skills.
• Strong PC knowledge and skills.
• US citizenship required.

Requirements

• Knowledge of Medicare requirements, laws, rules, and regulations related to payment for services billed to the Program.
• Experience in reviewing claims, performing medical reviews, and/or developing fraud cases.
• CFE or AHFI certification a plus.

Benefits

• Target Salary Range: $66,000 - $106,000.
• 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.

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.