Medicaid Fraud Auditor Team Lead

About Peraton

Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world's leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees solve the most daunting challenges that our customers face. Visit peraton.com to learn how we're keeping people around the world safe and secure.

Program Overview

Performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse in Medicare and Medicaid programs.

About The Role

SafeGuard Services (SGS), a subsidiary of Peraton, performs audits, investigations, data analysis, and medical reviews to detect, prevent, deter, reduce fraud, waste, and abuse.

We are looking to add a Medicaid Fraud Auditor Team Lead to our SGS team of talented professionals.

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, and the District of Columbia.

What You'll do:

As an Audit Team Lead, this individual's primary responsibilities include achieving quality objectives, providing day-to-day workload oversight to promote timely development and resolution of Medicaid audits and providing mentoring and guidance to Audit team members. The individual exercises significant independent judgment within broadly defined policies and practices to determine the best method for accomplishing work and achieving objectives within established timelines.

• Oversee the development and progression of audits from initiation through completion, including planning, audit testing, analysis, findings, provider communications, and issuance of final finding reports.
• Provide day-to-day oversight and direction for assigned Auditors conducting Medicaid audits. The Team Lead is responsible for ensuring that audits are appropriately planned, progressed, documented, reviewed, and completed in accordance with applicable federal and state Medicaid requirements, established audit methodologies.
• Provide technical guidance and consultation to Auditors regarding Medicaid requirements, audit methodology, regulatory interpretation, claims analysis, documentation, and development of findings.
• Review individual workload during monthly auditor meetings; assist with prioritizing and conduct QC for staff.
• Establish priorities and monitor staff workloads to ensure resources are appropriately aligned with audit requirements and metrics.
• Monitor the quality of WMM/UCM.
• Monitor timeliness for audit updates and escalate to management as necessary.
• Mentor team members so that they can identify previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development.
• Act as a point of contact for manager.

Essential Functions Include:

• Ability to perform research and draw conclusions
• Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
• Ability to organize a case file, accurately and thoroughly document all steps taken
• Ability to compose correspondence, reports and referral summary letters
• Ability to educate providers, provider associations, law enforcement, other contractors and beneficiary advocacy groups on program safeguard matters
• Ability to communicate effectively, internally and externally
• Ability to interpret laws and regulations
• Ability to exercise independent judgment while working within established policies, procedures, and audit methodologies.
• Ability to work with staff managing multiple assignments, establishing priorities, meeting deadlines, and maintaining accurate audit documentation.
• Ability to handle confidential material
• Ability to report work activity on a timely basis
• Ability to work independently and as a member of a team to deliver high-quality work
• Ability to attend meetings, training, and conferences, overnight travel required
• Document QC results in WMM according to record type
• Coordinate with other designated leads, if necessary, for coverage for periods where the lead is out of the office during work hours.

Qualifications

Basic Qualifications:

• Minimum of 8 years with BS/BA; or 12 years with a HS Diploma/equivalent
• Experience conducting Medicaid, Medicare, healthcare, compliance, financial, internal, or program integrity audits.
• Experience leading staff in identifying and documenting noncompliance, improper payments, billing irregularities, or potential overpayments.
• Strong written, verbal communication and organization skills.
• Strong PC knowledge and Microsoft Office tools.
• US Citizen

Desirable Qualifications:

• Direct Medicaid audit or Medicaid Program Integrity experience.
• Experience researching and applying state-specific Medicaid requirements.
• Experience auditing hospitals, pharmacies, laboratories, physicians, dental providers, behavioral health providers, personal care providers, managed care organizations, or other Medicaid provider types.
• Experience with Medicaid provider compliance and billing requirements.
• Experience identifying Medicaid overpayments.
• Professional certification such as CPA, CIA, CFE, CHC, CPC, or a comparable audit, fraud, healthcare, or compliance credential preferred.

Details

Target Salary Range: $66,000 - $106,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual's experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.

Benefits Statement: Peraton offers eligible employees a variety of benefits including medical, dental, vision, life, health savings account, short/long term disability, EAP, parental leave, 401(k), paid time off (PTO) for vacation, and company paid holidays. A full listing of available benefits can be viewed at https://www.careers.peraton.com/benefits.

Application Statements: The application period for the job is estimated to be 30 days from the job posting date. However, this timeline may be shortened or extended depending on business needs and the availability of qualified candidates. By applying to this job, you are expressing interest in the role and the Company. During the review of your application, you may be required to participate in an on-camera interview, as well as participate in a process to verify your identity. Use of artificial intelligence (AI) tools of any kind during Peraton interviews is strictly prohibited unless the candidate has obtained prior written authorization. All interview responses must be the candidate's own.

EEO:Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.