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 spanning the globe. They are seeking an Administrative Action Lead to oversee Medicaid administrative actions, mentor team members, and ensure compliance with federal and state requirements.

Responsibilities

• Act as the primary point of contact for the DRA Investigation Manager
• Assist team members with workflow development and preparation of administrative action documents
• Review workload, assist with prioritization, and perform quality control of administrative action work products
• Monitor the quality of UCM/WMM
• Monitor timeliness for case updates and escalating to management as necessary
• Monitor the progress of administrative actions to ensure appropriate remedies are pursued, including overpayment recovery and state-specific administrative actions
• Mentor staff in analyzing investigative findings, translating them into defensible administrative actions, and ensuring documentation supports state and CMS requirements
• Telework available from the Eastern Time Zone

Skills

• 8 years with BA; 10 years with AA or 12 years with High School diploma
• At least 5 years of experience in Medicaid or Medicare program integrity, investigations, audits, administrative actions, or healthcare compliance
• Experience working directly with state Medicaid agencies, state Program Integrity units, or other governmental partners in developing, coordinating, and resolving administrative actions, overpayment recoveries, provider appeals, or enforcement activities
• Strong communication and organization skills
• Strong PC knowledge and skills
• U.S. citizenship required
• Telework available from the Eastern Time Zone
• Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed the Program
• Experience in reviewing claims, performing medical review, and/or developing fraud cases

Benefits

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

Company Overview