Medicaid Fraud Auditor

Responsibilities

SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.

The Medicaid Fraud Auditor will conduct audits and reviews of various Medicaid programs to ensure compliance with federal and state program requirements and to identify exceptions of non-compliance that may result in the recovery of over-payments. The individual applies advance level of subject matter knowledge to solve a variety of common business issues. Works on problems with moderate to large complex scopes. Acts as an informed team member providing analysis of information and limited project direction input. Exercises independent judgment within defined practices and procedures to determine appropriate action. Follows established guidelines and correctly interprets rules, regulations and other guidance.. Evaluates unique circumstances, prepares analytical reviews, identifies exceptions prepare reports, and makes recommendations for corrective action. 

What you'll do:

• Provides research, interpret laws and regulations, performs data analysis and draws conclusions for projects;
• Conducts compliance audits of varied Medicaid case-types, audits claim submissions and performs ad-hoc focused audits;
• Handle several 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;
• Presenting issues of concern, verified through data, citing regulatory violations, proving schemes or scams to defraud the Government;
• Composing correspondence, reports, and referral summary letters;
• Works under general supervision and as a member of a team to deliver high quality work;
• Ensures that projects are timely, complete and accurate; and,
• Actively participants at meetings and attends training to further his business acumen.
• This is a remote position, candidates must reside within the Northeast Jurisdiction which include the states of Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, Pennsylvania, New Jersey, Delaware, Maryland, District of Columbia, and Virginia.

Qualifications

Basic Qualifications:

• Bachelors degree from an accredited college or university.
• Minimum …