Administrative Action Specialist Team Lead

About Peraton
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 solve the most daunting challenges that our customers face. Visit peraton.com to learn how we're keeping people around the world safe and secure.
Program Overview
Performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse in Medicare and Medicaid programs.
About The Role
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.
We are looking to add an Admin Action Specialist Team Lead to our SGS team of talented professionals.
As an Administrative Action Lead, this individual's primary responsibilities include achieving quality objectives, workload oversight to promote timely development and resolution of multiple administrative actions within an investigation. Provide mentoring and guidance to the administrative action team as well as guidance to the investigation teams on what is needed to pursue an action. The individual exercises significant independent judgment within broadly defined policies and practices to determine the best method for accomplishing work and achieving objectives.
What You'll do:
Act as a point of contact for manager
Work with CMS on proceeding with and finalizing administrative actions.
Assist team members with workflow and admin action development.
Review individual workloads during workload meetings; assist with prioritizing and conduct QC for staff.
Monitor the quality of WMM/UCM
Monitor timeliness for case updates and escalating to management as necessary.
Monitor the progress of the administrative action to ensure all timeframes and metrics are met.
Mentor team members so that they can proceed efficiently through the development of an action.
Partake in Investigation requested meetings to discuss admin actions. Partake in CMS' high-priority projects and provide direction to the team.
Develop an efficient workflow process and evaluate effectiveness
Telework available from East Coast
Qualifications
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.
Details
Target Salary Range: $66,000 - $106,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual's experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.
Benefits Statement: Peraton offers eligible employees a variety of benefits including medical, dental, vision, life, health savings account, short/long term disability, EAP, parental leave, 401(k), paid time off (PTO) for vacation, and company paid holidays. A full listing of available benefits can be viewed at https://www.careers.peraton.com/benefits.
Application Statements: The application period for the job is estimated to be 30 days from the job posting date. However, this timeline may be shortened or extended depending on business needs and the availability of qualified candidates. By applying to this job, you are expressing interest in the role and the Company. During the review of your application, you may be required to participate in an on-camera interview, as well as participate in a process to verify your identity. Use of artificial intelligence (AI) tools of any kind during Peraton interviews is strictly prohibited unless the candidate has obtained prior written authorization. All interview responses must be the candidate's own.
EEO:Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.

Work arrangement
Yes