[Remote] Medicaid Auditor/Investigator

Note: The job is a remote job and is open to candidates in USA. SafeGuard Services (SGS), a subsidiary of Peraton, conducts audits and reviews of Medicaid programs to ensure compliance with federal and state requirements and recover overpayments. The Medicaid Auditor/Investigator researches regulations, analyzes claims and billing patterns, documents findings, and makes recommendations and referrals related to fraud, waste, and abuse.

Responsibilities

• This individual will conduct audits and reviews of various Medicaid programs to ensure compliance with federal and state Medicaid program requirements and to recover over-payments for non-compliance
• 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

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

Benefits

• Remote work allowed 100%.
• Employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.

Company Overview