ResponsibilitiesSafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.
We are looking to add an Admin Action Specialist Team Lead to our SGS team of talented professionals.
As an Administrative Action Lead, this individual’s primary responsibilities include achieving quality objectives, workload oversight to promote timely development and resolution of multiple administrative actions within an investigation. Provide mentoring and guidance to the administrative action team as well as guidance to the investigation teams on what is needed to pursue an action. The individual exercises significant independent judgment within broadly defined policies and practices to determine the best method for accomplishing work and achieving objectives.
What You’ll do:
- Act as a point of contact for manager
- Work with CMS on proceeding with and finalizing administrative actions.
- Assist team members with workflow and admin action development.
- Review individual workloads during workload meetings; assist with prioritizing and conduct QC for staff.
- Monitor the quality of WMM/UCM
- Monitor timeliness for case updates and escalating to management as necessary.
- Monitor the progress of the administrative action to ensure all timeframes and metrics are met.
- Mentor team members so that they can proceed efficiently through the development of an action.
- Partake in Investigation requested meetings to discuss admin actions. Partake in CMS’ high-priority projects and provide direction to the team.
- Develop an efficient workflow process and evaluate effectiveness
- Telework available from East Coast
Qualifications
Required Qualifications:
- 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
Desirable Qualifications:
- Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed to the Program
- Experience in reviewing claims, performing medical reviews, and/or developing fraud cases
- CFE or AHFI certification a plus
Essential Functions Include:
- 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, accurately and thoroughly document all steps taken
- Ability to compose correspondence, 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
- Document QC results in WMM according to record type
- Coordinate with other designated leads, if necessary, for coverage for periods where the lead is out of the office during work hours.
Target Salary Range$66,000 - $106,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual’s experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.
