Quality Assurance Specialist

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.

The Quality Assurance Specialist is expected to perform quality assurance checks on Medicaid investigation and audit file documentation for the purpose of ensuring the adequacy of the information within the document and to ensure the quality of the product meet/exceed the client’s expectations.  Quality control reviews will assure that documents comply with federal regulations as well as internal quality control practices. Will work closely with investigators and administrative action personnel to provide a complete and quality product to our customers.

What you'll do:

• Quality Assurance works independently with minimal supervision and direction and as a team to complete requests timely and efficiently.
• Quality Assurance handles a multitude of document types/requests daily and determines appropriate prioritization to complete the workload.
• Quality Assurance verifies Protective Health Information (PHI) and Personally Identifiable Information (PII) and reviews content of all documents within the request.
• Quality Assurance communicates with requestor and follows up with any questions or re-works noted during the review of the documents.
• Quality Assurance adapts to handle priority requests at any time to ensure timeliness is met per CMS guidelines/metrics.
• Quality Assurance works with health privacy information maintaining confidentiality and demonstrates a clear understanding of the laws, rules and regulations concerning health privacy.
• Telework available from any state in US, preference would be Maine, New Hampshire, Vermont, New York, Rhode Island, Connecticut, Massachusetts, Pennsylvania, Delaware, District of Columbia, New Jersey, Maryland, Northern Virgina

Basic Requirements:

• 2 years with BS/BA; 0 years with MS/MA; 6 years with no degree.
• Proficient in editing and review skills.
• Knowledge of applicable regulatory and industry standards, including HIPAA and content review
• Proficient with reviews requiring extremely detail-oriented focus
• Strong communication, written and oral skills
• Strong organization skills and ability to prioritize workload appropriately
• Proficient in Microsoft Word, Excel, and PowerPoint, Access.
• US Citizenship Required

Essential Functions:

• Ability to communicate effectively, with both internal and external business partners.
• Ability to report workload status and activity on a timely basis.
• Ability to handle confidential material.
• Ability to conduct self-directed reviews to identify case documentation issues, assure clarity of language and adherence to investigative principles, as defined by CMS and Management.
• Ability to confirm accuracy of data submitted via documentation.
• Ability to review and verify document creation and revisions, to ensure documentation complies with internal quality control practices, and that all staff are using the correct version before distribution and implementation.
• Ability to approve finished products, returning documents for re-work, and confirming re-work.
• Ability to document review results by completing reports and logs.
• Ability to meet timeliness requirements as applicable.
• Ability to participate and support internal and external audits.
• Ability to update job knowledge by participating in educational opportunities
• Ability to work independently and as a member of a team to deliver high quality work.

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.