Admin Action Specialist – Medicare

🔥 1 hour ago

🇺🇸 United States – Remote

💵 $51k - $82k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Peraton

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

🏥 Healthcare

📦 Logistics

Consulting • Healthcare • Logistics

Peraton is a mission-focused enterprise that supports national security initiatives through advanced IT and cyber services. They provide capabilities in areas such as cyber defense, cloud operations, engineering, and intelligence. With a commitment to solving complex challenges, Peraton integrates data-driven technologies to ensure mission success for their military and government clients.

📋 Description

• Serve as a point of contact for CMS regarding administrative actions related to investigations • Provide training and mentoring • Maintain statistics on submitted administrative actions • Maintain template documents used to submit and process administrative actions • Review and verify evidence supporting administrative actions involving payment suspensions, revocations, overpayments and other remedies • Work with investigative teams to ensure documentation supports administrative actions • Coordinate with CMS, law enforcement and the Medicare Administrative Contractor throughout each action • Monitor workload and ensure actions meet Program Integrity Manual timeframes • Prepare and submit administrative action packages to CMS and MACs for approval and processing • Speak to administrative action development • Document QC results in WMM according to record type • Assist with workflow development • Review workloads during monthly meetings, assist with prioritization and conduct staff quality control • Monitor WMM/UCM quality • Monitor timeliness of case updates and escalate to management as necessary • Monitor investigations and cases to ensure all available remedies are used • Mentor team members in identifying previously undetected fraud, waste or abuse through research, analysis and development

🎯 Requirements

• 2 years with BS/BA; 0 years with MS/MA; 6 years with a high school 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 review, and/or developing fraud cases • Strong PC knowledge and skills • Ability to attend meetings, training, and conferences; overnight travel may be required • U.S. citizenship required • CFE or AHFI certification (desirable) • 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

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • Life insurance • Health savings account • Short-term disability • Long-term disability • Employee assistance program (EAP) • Parental leave • 401(k) • Paid time off (PTO) for vacation • Company-paid holidays • Potential overtime eligibility • Potential shift differential • Discretionary bonus eligibility

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