[Hiring] Fraud Investigator Advisor @Peraton

Role Description

The Fraud Investigator Advisor will support the prosecution of cases within the SE UPIC and act as a liaison between the SE UPIC, HHS OIG, State Medicaid Agencies (SMA), and the Department of Justice (DOJ). The selected candidate will be required to understand and develop expertise in Medicare and Medicaid policies to prepare cases for prosecution. The individual exercises significant independent judgment within broadly defined policies and practices to determine the best method for accomplishing work and achieving objectives.

• Assist investigators with case development
• Must be responsive to requests from USAO, DOJ
• Extensive travel required within the USA
• Monitor timeliness for case updates and escalate to management as necessary
• Monitor the progress of investigations and cases to ensure use of all available remedies, i.e., suspension, pre-pay reviews, revocation, etc.
• Mentor team members to identify previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development
• Conduct training on case development for prosecution, including best practices and lessons learned
• Attend regional meetings with stakeholders, including HHS OIG, FBI, SMA’s, and other Federal/State agencies
• Telework available from contiguous United States

Qualifications

• Minimum of 8 years with BS/BA; Minimum of 6 years with MS/MA; Minimum of 3 years with PhD
• Healthcare investigative experience required
• Previous experience testifying in Federal Court in related healthcare prosecutions
• Strong communication and organization skills
• Strong PC knowledge and skills
• Ability to travel within the US as needed
• Applicant must be a U.S. citizen

Requirements

• Knowledge of Medicare and Medicaid 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
• Documented experience working in a law enforcement environment specific to the Medicare and Medicaid Programs
• Documented experience in preparing and testifying for cases associated with Medicare and Medicaid rules, policies, and program requirements
• Master’s Degree preferred
• CFE or AHFI certification preferred

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

Target Salary Range

$86,000 - $138,000. 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.