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[Remote] Medicaid Fraud Auditor
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 Medicaid Fraud Auditor to conduct complex audits and reviews of medical service providers to ensure compliance with federal and state program requirements, while recommending recovery of over-payments for non-compliance.
Responsibilities
- Provides research, interprets laws and regulations, performs data analysis and draws conclusions for projects
- Uses good judgment conducting compliance audits of varied Medicaid case-types, auditing claim submissions and performing ad-hoc focused audits
- Handles multiple assignments concurrently; organizes and analyzes billing patterns; conducts interviews and obtains statements from beneficiaries/recipients and others
- Develops an understanding of the function to be audited and uses business knowledge, analytical skills, and experience in identifying findings and making recommendations for improvements
- Identifies compliance exceptions, conflicts of interest, improper payments
- Organizes a case file, accurately and thoroughly documents all steps taken
- Works independently or at times as part of a team, provide ongoing progress reports and updates on audit status
- Presents issues of concern verified through data, citing regulatory violations, proving schemes or scams to defraud the Government
- Compose correspondence, reports, and referral summary letters
- Works under general supervision and as a member of a team to deliver high quality work
- Ensure that projects are timely, complete and accurate; and
- Actively participates at meetings and attends training to further his business acumen
Skills
- 2 years with a Bachelor's degree; or High School diploma with 6 years experience in lieu of a degree
- 2+ years of related work experience
- Knowledge of internal audit/investigative policies and operating principles
- Strong research, analytical, interpersonal skills
- Strong familiarity with Microsoft Office tools, including intermediate to advanced knowledge of Excel and pivot tables
- US citizenship required
- Degree in finance, accounting or a health-related field preferred
- Financial and business acumen
- Intermediate audit/investigative skills
- Project management skills
- Knowledge of the healthcare industry, medical coding concepts and/or experience analyzing health care claims data
Benefits
- Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.
Company Overview
