[Hiring] Medicaid Fraud Auditor Team Lead @Peraton

Role Description

SafeGuard Services (SGS), a subsidiary of Peraton, performs audits, investigations, data analysis, and medical reviews to detect, prevent, deter, reduce fraud, waste, and abuse. We are looking to add a Medicaid Fraud Auditor Team Lead to our SGS team of talented professionals. This is a remote position; candidates must reside within the Northeast Jurisdiction which includes the states of Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, Pennsylvania, New Jersey, Delaware, Maryland, and the District of Columbia.

As an Audit Team Lead, this individual’s primary responsibilities include:

• Achieving quality objectives.
• Providing day-to-day workload oversight to promote timely development and resolution of Medicaid audits.
• Providing mentoring and guidance to Audit team members.
• Exercising significant independent judgment within broadly defined policies and practices.
• Overseeing the development and progression of audits from initiation through completion, including planning, audit testing, analysis, findings, provider communications, and issuance of final finding reports.
• Providing day-to-day oversight and direction for assigned Auditors conducting Medicaid audits.
• Ensuring audits are appropriately planned, progressed, documented, reviewed, and completed in accordance with applicable federal and state Medicaid requirements.
• Providing technical guidance and consultation to Auditors regarding Medicaid requirements, audit methodology, regulatory interpretation, claims analysis, documentation, and development of findings.
• Reviewing individual workload during monthly auditor meetings; assisting with prioritizing and conducting QC for staff.
• Establishing priorities and monitoring staff workloads to ensure resources are appropriately aligned with audit requirements and metrics.
• Monitoring the quality of WMM/UCM.
• Monitoring timeliness for audit updates and escalating to management as necessary.
• Mentoring team members to identify previously undetected fraud, waste, or abuse.
• Acting as a point of contact for the manager.

Essential Functions Include:

• 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, accurately and thoroughly 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 exercise independent judgment while working within established policies, procedures, and audit methodologies.
• Ability to work with staff managing multiple assignments, establishing priorities, meeting deadlines, and maintaining accurate audit documentation.
• 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 required.
• Documenting QC results in WMM according to record type.
• Coordinating with other designated leads, if necessary, for coverage during periods where the lead is out of the office.

Qualifications

• Minimum of 8 years with BS/BA; or 12 years with a HS Diploma/equivalent.
• Experience conducting Medicaid, Medicare, healthcare, compliance, financial, internal, or program integrity audits.
• Experience leading staff in identifying and documenting noncompliance, improper payments, billing irregularities, or potential overpayments.
• Strong written, verbal communication, and organization skills.
• Strong PC knowledge and Microsoft Office tools.
• US Citizen.

Requirements

• Direct Medicaid audit or Medicaid Program Integrity experience.
• Experience researching and applying state-specific Medicaid requirements.
• Experience auditing hospitals, pharmacies, laboratories, physicians, dental providers, behavioral health providers, personal care providers, managed care organizations, or other Medicaid provider types.
• Experience with Medicaid provider compliance and billing requirements.
• Experience identifying Medicaid overpayments.
• Professional certification such as CPA, CIA, CFE, CHC, CPC, or a comparable audit, fraud, healthcare, or compliance credential preferred.

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.