[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.

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 as there may be times when the investigator needs to work 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
• Apply federal or state laws
• 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
• Appear in court to testify about work findings
• Perform research and draw conclusions
• Present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
• Organize a case file, accurately and thoroughly document all steps taken
• Compose correspondence, reports and referral summary letters
• Educate providers, provider associations, law enforcement, other contractors and beneficiary advocacy groups on program safeguard matters
• Communicate effectively, internally and externally
• Interpret laws and regulations
• Handle confidential material
• Report work activity on a timely basis
• Work independently and as a member of a team to deliver high quality work
• Attend meetings, training, and conferences, overnight travel required

Skills

• 5 years with BS/BA; 3 years with MS/MA; 0 years with PhD
• 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

• Telecommute 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.

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