Investigative Team Lead - Medicare

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 Investigative Team Lead to our SGS team of talented professionals.

 What You’ll do:

As an Investigative Team Lead, this individual’s 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.    

• Communication with CMS
• Attend FDOC and other CMS meetings
• There may be multiple of these individuals for a task order and they may lead significantly different activities
• Act as a point of contact for manager
• 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/UCM
• Monitor timeliness for case updates and escalating to management as necessary
• Monitor the progress of investigations 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.
• Telework available from contiguous U.S.

Basic Qualifications:

• Minimum of 8 years with BS/BA; Minimum of 6 years with MS/MA
• At least 6 years of relevant investigative experience required.
• CFE or AHFI certification preferred
• Strong communication and organization skills
• Strong PC knowledge and skills
• U.S. citizenship required

Desirable Qualifications:

The most competitive candidates will have:

• 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

Essential Functions:

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

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.