Administrative Action Specialist

🕒 Setembro 28

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $51.000 - $82.000 / ano

⏰ Tempo Integral

🟢 Júnior

🟡 Pleno

🚫👨‍🎓 Sem graduação necessária

🦅 Patrocina Visto H1B

Esta empresa já patrocinou vistos H1B no passado.

👻 Score fantasma 0%

O que significa: quão provável esta vaga está aberta sem contratação ativa.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

Candidatar-se

Encontrar Vagas Remotas Similares

Configurar Alerta de Email para Novas Vagas

📊 Verifique sua pontuação de currículo para esta vaga

Melhore suas chances de conseguir uma entrevista verificando sua pontuação de currículo antes de se candidatar.

Enviar Currículo

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 all administrative actions related to investigations • Develop and submit administrative actions to CMS for approval • Maintain a high-volume workload requiring quick actions and management of multiple metrics • Review and verify evidence supporting administrative actions related to 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 taken within required timeframes set forth in the Program Integrity Manual • Prepare and submit administrative action packages to CMS and MACs for approval and processing • Speak to administrative 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

• 2 years with BS/BA or 6 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