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icims

Administrative Action Specialist Team Lead

Peraton
Remote, USA
Full-time
Senior · 8+ years experience
Remote
USD 66000-106000 yearly / year
Discovered 4 weeks ago
WMMUCM

Full Job Posting

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.

Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world’s leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can’t be done by solving the most daunting challenges facing our customers. Visit peraton.com to learn how we’re keeping people around the world safe and secure.

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