Program Integrity Audit Manager

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.

What you'll do:

The Program Integrity Audit Manager position will provide day-to-day supervision and direction to assigned audit team. Ensures operations are running optimally and processes and procedures are being followed. Maintains appropriate staffing levels and plans and organizes workload and staff assignments according to the needs of the audit. Manages the overall performance, productivity, and quality assurance of the assigned audit team. Maximizes opportunities of the audit; optimizes timely audit processes and efficiencies. Involved in formulating all budget related aspects of the audit. Executes and adjusts to budget demands.

Responsibilities:

• Analytics -- Performs complex operational and financial analysis. Analyses to include operations, statistics, financial/ROI, and aging. Synthesizes results and communicates results to stakeholders in formal reports. Synthesize results to identify indicators of poor performance and communicate findings to Medicaid leadership team, customer, and stakeholders.
• People/Performance Management -- Consistent with good people management practices and company values, providing managerial leadership and directing the selection, supervision, evaluation, and development of staff. Set objectives and conduct performance reviews for direct reports and share insights collectively with the management team on overall team performance. Work with Human Resources to recommend and implement performance management, progression, and compensation actions as warranted. Resolve employee concerns and other sensitive people issues consistent with Human Resources policies and guidelines.
• Staff Training and Development -- Follow established processes for training and career progression to enable revenue growth and auditor and support staff development and engagement. Promote & participate in knowledge sharing activities such as best practices, benchmarking, whitepapers and IT tools enhancement. Ensure that all levels of staff are properly trained on policies, procedures and best practices and that proper training, education and required certifications are maintained as required. Innate ability to share knowledge and develop audit skills in others. Broadly fosters formal and informal knowledge sharing activities.
• Audit Concepts Development -- Highly involved in the development and review of new and existing concepts. Ensures achievement of desired goals in terms of recoveries, collectability and client acceptance.
• Revenue Producing -- Assigns proportionate workload to team that yields maximum productivity and achievable, profitable results. Evaluates and manages the priority of audit projects in order to satisfy client expectations as well as pursuing the best revenue opportunities.
• Customer Orientation -- Treats customers/clients both internal and external as number one priority, is committed to continuous quality improvement, is courteous and responsive to customer's needs, meets or exceeds all customer commitments. Effectively moves audit work forward without undue strain.
• Quality Assurance -- Direct accountability for overall Quality Control Process within the audit. Demonstrates advanced expertise and comprehension (knowledge) of claim categories, claim types. Holds the Audit team accountable for ensuring submission and execution of quality work, proper use of available proprietary software, reports and IT resources to conduct audits.
• Regulatory/Compliance -- Demonstrates understanding of CMS and Peraton policies & procedures. Assures confidentiality and security of all data. Demonstrates the skills, knowledge, and ability to ensure that our environment is a safe one, complying with industry standards.  
• Telework available from continuous United States

Basic Qualifications:

• Minimum High School diploma with 6 years of related experience in a telecommuting environment and managing staff who all work remotely; ability to successfully manage a team and collaborate with others.
• At least two (2) years management experience required; people management experience
• Excellent verbal and written communication skills required as well as strong PC skills.
• Knowledge of Medicaid requirements, laws, rules, and regulations related to payment for services billed to the Program.
• This position requires proven leadership skills and knowledge of the Medicaid Program as it pertains to reviewing claims and provider behavior for indications of potential fraud, waste, and abuse
• Advanced computer skills in Excel required.
• Ability to effectively work independently and as a member of a team.
• Designing audit strategies for performing provider reviews.
• Coordination of audit activities with internal and external partners.
• Understanding of budget, forecast and workforce planning required.
• Experience leading teams in a fast-paced environment.
• US Citizenship is required.

Preferred Qualifications:

• Working knowledge of Managed Care Plans (MCPs) and experience auditing MCPs preferred.
• Ability to evaluate processes and find innovative solutions to improve efficiency.
• Experience in accounting, finance, accounts payable, or audit preferred.
• Working knowledge and understanding of Generally Accepted Accounting Principles or Generally Accepted Government Auditing Standards preferred but not required.

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.