Note: The job is a remote job and is open to candidates in USA. SafeGuard Services (SGS), a subsidiary of Peraton, hires a Medicaid Auditor/Investigator to audit and review Medicaid programs for compliance with federal and state requirements. The role analyzes billing and claims data, investigates potential fraud, waste, abuse, and improper payments, and documents findings and recommendations.

Responsibilities

• Provides research, interprets laws and regulations, performs data analysis and draws conclusions for projects
• Conducts compliance audits of varied Medicaid case-types, audits claim submissions and performs ad-hoc focused audits
• Handle several assignments concurrently; organizes and analyzes billing patterns; conducts interviews and obtains statements from beneficiaries/recipients and others
• Develops an understanding of the function to be audited and uses business knowledge, analytical skills, and experience in identifying findings and making recommendations for improvements Identifies compliance exceptions, conflicts of interest, improper payments
• Organizes a case file, accurately and thoroughly documents all steps taken
• Works independently or at times as part of a team, provides ongoing progress reports and updates on audit status
• Presents issues of concern, verified through data, citing regulatory violations, proving schemes or scams to defraud the Government
• Compose correspondence, reports, and referral summary letters
• Works under general supervision and as a member of a team delivering high-quality work
• Ensures that projects are timely, complete and accurate
• Actively participants at meetings and attends training to further his business acumen
• 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, District of Columbia, and Virginia

Skills

• 2 years with BS/BA or 6 years with a HS diploma
• Experience in accounting or closely related business field, law enforcement, health science or related field
• Knowledge of internal audit/investigative policies and operating principles
• Understanding of Medicare/Medicaid or healthcare auditing
• Strong Research and analytical skills
• Strong familiarity with Microsoft Office tools, including intermediate to advanced knowledge of Excel
• Must be a US Citizen
• Intermediate financial and business acumen
• Intermediate audit/investigative skills
• Project management skills
• Knowledge of the healthcare industry and medical coding concepts and/or experience analyzing health care claims data is preferred

Benefits

• Remote work allowed 100%; candidates must reside within the Northeast Jurisdiction, including Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, Pennsylvania, New Jersey, Delaware, Maryland, the District of Columbia, and Virginia.

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