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Team Lead Investigations - Medicaid

Company: Peraton
Location: Herndon
Posted on: June 12, 2021

Job Description:

Peraton Overview

Peraton drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the worlds 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 22,000 employees do the cant be done, solving the most daunting challenges facing our customers.

Qualifications

Prerequisites:

  • BS 10-12, MS 8-10, Phd 5-7
  • At least 5 years of relevant investigative experience required.
  • Telework for Eastern Time Zone
  • Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed the Program
  • CFE or AHFI certification preferred
  • Strong communication and organization skills
  • Experience in reviewing claims, performing medical review, and/or developing fraud cases
  • Strong PC knowledge and skills

Essential Functions:

  • There may be multiple of these individuals for a task order and they may lead significantly different activities
  • Examples of Team Leads responsibilities include:
  • Assist team members with workflow development
  • Review individual workload during monthly meetings; assist with prioritization and conduct QC for staff
  • Monitor the quality of WMM/FID
  • Monitor timeliness for case updates and escalating to management as necessary
  • Monitor the progress ofinvestigations and cases to ensure use of all available remedies, i.e., suspension, pre-pay reviews, revocation, etc.
  • Mentor team members so that they can identify previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development.
  • 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
  • Document QC results in WMM according to record type
  • Act as a point of contact for manager

  • Coordinate with other designated leads if necessary, for coverage for periods where the lead is out of the office during work hours.

Responsibilities

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 preventedmore than$9.65 billion in inappropriate payments,consisting of nearly $5.98billion in proactively Prevented Dollars and more than $3.69 billion in Recovered 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:

As an Investigative Team Lead, this individuals primary responsibilities include achieving quality objectives, workload oversight to promote timely development and resolution of investigations and development of cases for referral to law enforcement or other entities and provide mentoring and guidance to investigative team. The individual exercises significant independent judgment within broadly defined policies and practices to determine the best method for accomplishing work and achieving objectives.

For Colorado Residents

Colorado Salary Minimum: $82,555.20

Colorado Salary Maximum:$176,467.20

The estimate displayed represents the typical salary range for this position, and is just one component of Perspecta's total compensation package for employees. Other rewards may include annual bonuses, short- and long-term incentives, and program-specific awards. In addition, Perspecta provides a variety of benefits to employees.

Keywords: Peraton, Germantown , Team Lead Investigations - Medicaid, Other , Herndon, Maryland

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