Administrative Action Specialist

🕒 5 dias atrás

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $66.000 - $106.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

🦅 Patrocina Visto H1B

Esta empresa já patrocinou vistos H1B no passado.

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Peraton

SiteLinkedInTodas as Vagas

10.000+ funcionários

💼 Consultoria

🏥 Saúde

📦 Logística

Consulting • Healthcare • Logistics

A Peraton é uma empresa focada em missões que apoia iniciativas de segurança nacional por meio de serviços avançados de TI e cibernéticos. Eles oferecem capacidades em áreas como defesa cibernética, operações em nuvem, engenharia e inteligência. Com um compromisso em resolver desafios complexos, a Peraton integra tecnologias baseadas em dados para garantir o sucesso das missões de seus clientes militares e governamentais.

Descrição

• Serve as a Point of Contact for CMS regarding administrative actions related to investigations • Develop and submit administrative actions to CMS for approval • Review and verify evidence supporting payment suspensions, revocations, overpayments, prepayment edits, and auto-denial edits • Work with Investigative Teams to ensure documentation is sufficient to support administrative actions • Work with CMS, law enforcement, and the Medicare Administrative Contractor throughout the life of each action • Monitor workload to ensure actions are completed within timeframes set forth in the Program Integrity Manual • Prepare and submit administrative action packages to CMS and MACs for approval and processing • Speak to action development • Assist team members with workflow development • Review individual workload during monthly meetings and assist with prioritization • Monitor the quality of WMM/UCM • Monitor timeliness for case updates and escalate to management as necessary • Monitor investigation and case progress to ensure use of available remedies • Document QC results in WMM according to record type

🎯 Requisitos

• 5 years with BS/BA or 9 years with a HS Diploma/equivalent • Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed to the Program • Strong communication and organization skills • Experience in reviewing claims, performing medical reviews, and/or developing fraud cases • Strong PC knowledge and skills • 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 and 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 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 may be required • US. citizenship required • CFE or AHFI certification desirable • Medicare claims processing experience desirable

🏖️ Benefícios

• Telework available from eastern time zone • Employees may be eligible for overtime • Employees may be eligible for shift differential • Employees may be eligible for a discretionary bonus