[Remote] Fraud Investigator - Medicaid

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 globally. They are seeking a Fraud Investigator to perform complex investigations of medical professional service providers, develop cases for action, and work with internal and external resources to address fraud, waste, and abuse in healthcare.ResponsibilitiesPerform 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 actionsWork with internal resources and external agencies to develop cases and corrective actions as well as respond to requests for data and supportUse good judgment and may work independently with minimum supervision and directionWork as part of a team as there may be times when the investigator needs to work with state and/or federal investigators and other personnelHandle multiple caseload assignments concurrentlyOrganize and analyze complex evidentiary patternsInterview and obtain statements from witnesses and othersComplete complex investigative reports that apply regulations or rules to the program(s) affected by the behavior being investigatedApply federal or state lawsResearch and understand the relevant offenses being investigatedConduct efficient and effective investigations concerning those alleged offenses and detect or verify suspected violationsObtain information and evidence by observation, record examination, and interviewAnalyze 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 issuesPrepare correspondence; be objective and accurate and communicate with others with tactReact to unplanned situations, be flexible in planning their activities and adopt effective courses of actionMaintain confidentiality and understand all the laws, rules and regulations concerning health privacyAppear in court to testify about work findingsPerform research and draw conclusionsPresent issues of concern, citing regulatory violations, alleging schemes or scams to defraud the GovernmentOrganize a case file, accurately and thoroughly document all steps takenCompose correspondence, reports and referral summary lettersEducate providers, provider associations, law enforcement, other contractors and beneficiary advocacy groups on program safeguard mattersCommunicate effectively, internally and externallyInterpret laws and regulationsHandle confidential materialReport work activity on a timely basisWork independently and as a member of a team to deliver high quality workAttend meetings, training, and conferences, overnight travel requiredSkills5 years with BS/BA; 3 years with MS/MA; 0 years with PhDInvestigative experienceStrong investigative skillsStrong communication and organization skillsStrong PC knowledge and skillsU.S. citizenship requiredStrong background in investigationsExperience in reviewing claims for technical requirements, performing medical review, and/or developing fraud casesKnowledge of investigative practices regarding healthcare providersKnowledge of Medicare and/or Medicaid programs and the rules, regulations, policies and proceduresBackground in evaluating, reviewing and analyzing medical claims and recordsAbility to learn and operate a variety of data systems, equipment and tools used in investigationsBenefitsTelecommute Options: Remote work allowed 100%Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.Company OverviewPeraton 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 https://www.peraton.com/.