Responsibilities
SafeGuard 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 a Fraud Investigator Advisor to our SGS team of talented professionals
What You’ll do:
This Fraud Investigator Advisor will support the prosecution of cases within the SE UPIC and act as a liaison between the SE UPIC, HHS OIG, State Medicaid Agencies (SMA), and the Department of Justice (DOJ). The selected candidate will be required to understand and develop expertise in Medicare and Medicaid policies to prepare cases for prosecution. The individual exercises significant independent judgment within broadly defined policies and practices to determine the best method for accomplishing work and achieving objectives.
- Assist investigators with case development
- Must be responsive to requests from USAO, DOJ
- Extensive travel required within the USA
- Monitor timeliness for case updates and escalating to management as necessary
- Monitor the progress of investigations and cases to ensure use of all available remedies, i.e., suspension, pre-pay reviews, revocation, etc.
- Mentor team members so that they can identify previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development.
- Conduct training on case development for prosecution, including best practices, and lessons learned
- Attend regional meetings with stakeholders, including HHS OIG, FBI, SMA’s, and other Federal/State agencies.
- Telework available from contiguous United States
Qualifications
Basic Qualifications:
- Minimum of 8 years with BS/BA; Minimum of 6 years with MS/MA; Minimum of 3 years with PhD
- Healthcare investigative experience required.
- Previous experience testifying in Federal Court in related healthcare prosecutions.
- Strong communication and organization skills
- Strong PC knowledge and skills
- Ability to travel within the US as needed
- Applicant must be a U.S. citizen
Desirable Qualifications:
The most competitive candidates will have:
- Knowledge of Medicare and Medicaid requirements, laws, rules and regulations related to payment for services billed the Program
- Experience in reviewing claims, performing medical reviews, and/or developing fraud cases
- Documented experience working in a law enforcement environment specific to the Medicare and Medicaid Programs.
- Documented experience in preparing and testifying for cases associated with Medicare and Medicaid rules, policies, and program requirements.
- Master’s Degree preferred
- CFE or AHFI certification preferred
Essential Functions:
- 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 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
- Ability to attend meetings, training, and conferences, overnight travel 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$86,000 - $138,000. 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.
Benefits Statement
Peraton offers eligible employees a variety of benefits including medical, dental, vision, life, health savings account, short/long term disability, EAP, parental leave, 401(k), paid time off (PTO) for vacation, and company paid holidays. A full listing of available benefits can be viewed at https://www.careers.peraton.com/benefits.
Application StatementsThe application period for the job is estimated to be 30 days from the job posting date. However, this timeline may be shortened or extended depending on business needs and the availability of qualified candidates. By applying to this job, you are expressing interest in the role and the Company. During the review of your application, you may be required to participate in an on-camera interview, as well as participate in a process to verify your identity. Use of artificial intelligence (AI) tools of any kind during Peraton interviews is strictly prohibited unless the candidate has obtained prior written authorization. All interview responses must be the candidate’s own.
