Fraud Investigator – Medicare
Posted 9ds ago
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Job Description
Fraud Investigator investigating Medicare provider fraud, waste, and abuse for Peraton subsidiary SafeGuard Services. Developing cases, analyzing claims, and supporting referrals and corrective actions.
Responsibilities:
- Perform high-level complex investigations of medical professional service providers
- Develop cases for referral to law enforcement, education, overpayment recovery, and other administrative actions
- Work with internal resources and external agencies to develop cases and corrective actions
- Respond to requests for data and support
- Handle multiple caseload assignments concurrently
- Organize and analyze complex evidentiary patterns
- Interview witnesses and others and obtain statements
- Complete complex investigative reports applying applicable regulations, rules, and laws
- Research relevant offenses and conduct investigations to detect or verify suspected violations
- Obtain information and evidence through observation, record examination, and interview
- Analyze investigation results and determine appropriate corrective steps
- Prepare correspondence and referral summary letters
- Maintain confidentiality of health privacy information
- Conduct site verifications to verify provider operational status
- Appear in court to testify about work findings when required
- Educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups on program safeguard matters
- Report work activity in a timely manner
- Attend meetings, training, and conferences
Requirements:
- 5 years with BS/BA; 3 years with MS/MA; 0 years with PhD
- Investigative experience
- Strong investigative skills
- Strong communication and organization skills
- Strong PC knowledge and skills
- U.S. citizenship required
- Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases
- Knowledge of investigative practices regarding healthcare providers
- Knowledge of Medicare program and the rules, regulations, policies and procedures
- Background in evaluating, reviewing and analyzing medical claims and records
- Ability to learn and operate a variety of data systems, equipment and tools used in investigations
Benefits:
- Telework available from South Florida
- Overnight travel required
- Employees may be eligible for overtime
- Employees may be eligible for shift differential
- Employees may be eligible for a discretionary bonus
