What are the responsibilities and job description for the Fraud Investigator - Medicare position at Peraton?
Peraton 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 and highly differentiated national security solutions and technologies that keep people safe and secure. Peraton serves as a valued partner to essential government agencies across the intelligence, space, cyber, defense, civilian, health, and state and local markets. Every day, our employees do the can’t be done, solving the most daunting challenges facing our customers.
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.
Since 1999, SGS has prevented nearly $9.8 billion in inappropriate payments, consisting of more than $6 billion in proactively Prevented Dollars (including Savings from Revocations) and more than $3.7 billion in Recovered Overpayment Dollars. Our experience with fraud and abuse analytics has resulted in the referral of thousands of cases to law enforcement and resulted in successful criminal and civil prosecution and civil monetary penalties.
Position Overview:
The position is expected to perform high level complex investigations of medical professional service providers and develop cases for future action, including referral to law enforcement, education, over payment recovery and other administrative actions. Will work with internal resources and external agencies to develop cases and corrective actions as well as respond to requests for data and support.
The investigator also may work as part of a team as there may be times when the investigator needs to work with state and/or federal investigators and other personnel. An investigator handles multiple caseload assignments concurrently; organizes and analyzes complex evidentiary patterns; interviews and obtains statements from witnesses and others.
Investigators may also be required to complete complex investigative reports that apply regulations or rules to the program(s) affected by the behavior being investigated.
Investigators are expected to research and understand the relevant offenses being investigated; conduct efficient and effective investigations concerning those alleged offenses and detect or verify suspected violations; obtain information and evidence by observation, record examination, and interview. Investigators then analyze the results of the investigation to ascertain if the allegations have been corroborated and work with others to determine the appropriate steps that need to be taken to address the issues.
As part of an investigation, the investigator will need to prepare correspondence; be objective and accurate and communicate with others with tact.
As investigators will be working with health privacy information, they also must maintain confidentiality and understand all the laws, rules and regulations concerning health privacy.
Basic Qualifications:
Bachelors and 5-7 years experience, Masters and 3-5 years experience, PhD and 0-2 years experience
3-5 years investigative experience preferred
Strong investigative skills
Strong communication and organization skills
Strong PC knowledge and skills
Desirable Qualifications:
Strong background in investigations.
Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases
Knowledge of investigative practices regarding healthcare providers.
Knowledge of Medicare and/or Medicaid programs and the rules, regulations, policies and procedures
Background in evaluating, reviewing and analyzing medical claims and records
Ability to learn and operate a variety of data systems, equipment and tools used in investigations
Essential Functions:
This position may require the incumbent to appear in court to testify about work findings.
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 Colorado Salary Minimum: $51,900
Colorado Salary Maximum: $126,000
The estimate displayed represents the typical salary range for this position, and is just one component of Peraton's total compensation package for employees. Other rewards may include annual bonuses, short- and long-term incentives, and program-specific awards. In addition, Peraton provides a variety of benefits to employees.
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.
Since 1999, SGS has prevented nearly $9.8 billion in inappropriate payments, consisting of more than $6 billion in proactively Prevented Dollars (including Savings from Revocations) and more than $3.7 billion in Recovered Overpayment Dollars. Our experience with fraud and abuse analytics has resulted in the referral of thousands of cases to law enforcement and resulted in successful criminal and civil prosecution and civil monetary penalties.
Position Overview:
The position is expected to perform high level complex investigations of medical professional service providers and develop cases for future action, including referral to law enforcement, education, over payment recovery and other administrative actions. Will work with internal resources and external agencies to develop cases and corrective actions as well as respond to requests for data and support.
The investigator also may work as part of a team as there may be times when the investigator needs to work with state and/or federal investigators and other personnel. An investigator handles multiple caseload assignments concurrently; organizes and analyzes complex evidentiary patterns; interviews and obtains statements from witnesses and others.
Investigators may also be required to complete complex investigative reports that apply regulations or rules to the program(s) affected by the behavior being investigated.
Investigators are expected to research and understand the relevant offenses being investigated; conduct efficient and effective investigations concerning those alleged offenses and detect or verify suspected violations; obtain information and evidence by observation, record examination, and interview. Investigators then analyze the results of the investigation to ascertain if the allegations have been corroborated and work with others to determine the appropriate steps that need to be taken to address the issues.
As part of an investigation, the investigator will need to prepare correspondence; be objective and accurate and communicate with others with tact.
As investigators will be working with health privacy information, they also must maintain confidentiality and understand all the laws, rules and regulations concerning health privacy.
Basic Qualifications:
Bachelors and 5-7 years experience, Masters and 3-5 years experience, PhD and 0-2 years experience
3-5 years investigative experience preferred
Strong investigative skills
Strong communication and organization skills
Strong PC knowledge and skills
Desirable Qualifications:
Strong background in investigations.
Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases
Knowledge of investigative practices regarding healthcare providers.
Knowledge of Medicare and/or Medicaid programs and the rules, regulations, policies and procedures
Background in evaluating, reviewing and analyzing medical claims and records
Ability to learn and operate a variety of data systems, equipment and tools used in investigations
Essential Functions:
This position may require the incumbent to appear in court to testify about work findings.
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 Colorado Salary Minimum: $51,900
Colorado Salary Maximum: $126,000
The estimate displayed represents the typical salary range for this position, and is just one component of Peraton's total compensation package for employees. Other rewards may include annual bonuses, short- and long-term incentives, and program-specific awards. In addition, Peraton provides a variety of benefits to employees.
Salary : $10 - $51,900
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