[Remote] Medicaid Fraud Auditor

Note: The job is a remote job and is open to candidates in USA. Peraton is a next-generation national security company that drives missions of consequence. They are seeking a Medicaid Fraud Auditor to conduct complex audits and reviews of medical service providers to ensure compliance with federal and state program requirements, while recommending recovery of over-payments for non-compliance.

Responsibilities

• Provides research, interprets laws and regulations, performs data analysis and draws conclusions for projects
• Uses good judgment conducting compliance audits of varied Medicaid case-types, auditing claim submissions and performing ad-hoc focused audits
• Handles multiple 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, provide 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 to deliver high quality work
• Ensure that projects are timely, complete and accurate; and
• Actively participates at meetings and attends training to further his business acumen

Skills

• 2 years with a Bachelor's degree; or High School diploma with 6 years experience in lieu of a degree
• 2+ years of related work experience
• Knowledge of internal audit/investigative policies and operating principles
• Strong research, analytical, interpersonal skills
• Strong familiarity with Microsoft Office tools, including intermediate to advanced knowledge of Excel and pivot tables
• US citizenship required
• Degree in finance, accounting or a health-related field preferred
• Financial and business acumen
• Intermediate audit/investigative skills
• Project management skills
• Knowledge of the healthcare industry, medical coding concepts and/or experience analyzing health care claims data

Benefits

• Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.

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