[Remote] Fraud Investigator (Administrative Actions) - Medicare

Note: The job is a remote job and is open to candidates in USA. Peraton is a next-generation national security company that drives missions of consequence. They are seeking a Fraud Investigator to perform complex investigations of medical professional service providers, develop cases for future action, and collaborate with internal and external resources to address fraud, waste, and abuse in healthcare. Responsibilities • Perform high level complex investigations of medical professional service providers and develop cases for future action, including referral to law enforcement, education, over payment recovery and other administrative actions. • Work with internal resources and external agencies to develop cases and corrective actions as well as respond to requests for data and support. • Use good judgment and may work independently with minimum supervision and direction. • Work as part of a team with state and/or federal investigators and other personnel. • Handle multiple caseload assignments concurrently; organize and analyze complex evidentiary patterns; interview and obtain statements from witnesses and others. • Complete complex investigative reports that apply regulations or rules to the program(s) affected by the behavior being investigated. • Research and understand the relevant offenses being investigated; conduct efficient and effective investigations concerning those alleged offenses and detect or verify suspected violations; obtain information and evidence by observation, record examination, and interview. • Analyze the results of the investigation to ascertain if the allegations have been corroborated and work with others to determine the appropriate steps that need to be taken to address the issues. • Prepare correspondence; be objective and accurate and communicate with others with tact. • React to unplanned situations, be flexible in planning their activities and adopt effective courses of action. • Maintain confidentiality and understand all the laws, rules and regulations concerning health privacy. Skills • 5 years with BS/BA; 3 years with MS/MA • Investigative experience • Strong investigative skills • Strong communication and organization skills • Strong PC knowledge and skills • U.S. citizenship required • Strong background in investigations. • Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases • Knowledge of investigative practices regarding healthcare providers. • Knowledge of Medicare and/or Medicaid programs and the rules, regulations, policies and procedures • Background in evaluating, reviewing and analyzing medical claims and records • Ability to learn and operate a variety of data systems, equipment and tools used in investigations Benefits • Employees may be eligible for overtime • Shift differential • Discretionary bonus Company Overview • Peraton Fearlessly solving the toughest national security challenges. It was founded in 1992, and is headquartered in Woodbridge, New Jersey, USA, with a workforce of 10001+ employees. Its website is Apply tot his job