Administrative Action Specialist – Team Lead

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $66k - $106k / year

⏰ Full Time

🟠 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

• Achieve quality objectives and oversee workload to promote timely development and resolution of multiple administrative actions within an investigation • Mentor and guide the administrative action team • Guide investigation teams on requirements for pursuing an administrative action • Act as a point of contact for the manager • Work with CMS on proceeding with and finalizing administrative actions • Assist team members with workflow and administrative action development • Review workloads during workload meetings, assist with prioritization, and conduct quality control for staff • Monitor the quality of WMM/UCM • Monitor timeliness for case updates and escalate to management as necessary • Monitor administrative action progress to ensure timeframes and metrics are met • Participate in investigation-requested meetings to discuss administrative actions • Participate in CMS high-priority projects and provide direction to the team • Develop efficient workflow processes and evaluate their effectiveness • Research issues and draw conclusions • Present concerns, regulatory violations, and alleged fraud schemes or scams to defraud the Government • Organize case files and document investigative steps • Compose correspondence and reports • Report team work activity on a timely basis • Document QC results in WMM according to record type • Coordinate coverage with other designated leads during absences

🎯 Requirements

• Minimum of 8 years with BS/BA or 12 years of experience and a HS Diploma • 8 years of relevant investigative experience required • Knowledge of Medicare requirements, laws, rules and regulations related to payment of services billed to the Program • Medicare claims processing knowledge • Strong communication and organization skills • Strong PC knowledge and skills • US citizenship required • Experience in reviewing claims, performing medical reviews, and/or developing fraud cases • CFE or AHFI certification a plus • Ability to perform research and draw conclusions • Ability to present issues of concern, citing regulatory violations and 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 and reports • 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 for the team • 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 • Ability to document QC results in WMM according to record type • Ability to coordinate with other designated leads for coverage during absences

🏖️ Benefits

• Telework available from East Coast • Employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay • Equal opportunity employment, including disability and protected veterans, or other characteristics protected by law