Fraud Investigator Admin Action

Responsibilities

SafeGuard Services (reputed company), a subsidiary of reputed company, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and reputed company referrals to recover fraud, waste, and abuse. We are looking to add a Fraud Investigator Admin Action Specialist to our reputed company team of talented professionals. The Fraud Investigator Admin Action Specialist is responsible for being a reputed company of Contact for Investigations, MAC and CMS regarding reputed company administrative actions reputed company to investigations.

• Review and verify evidence supporting an administrative action as it relates to payment suspensions, revocations, overpayments as well as other administrative actions that can be pursued.
• Work with the Investigations, Medical Review and Data teams to ensure that the documentation gathered is sufficient to support an administrative action.
• Making administrative action recommendation to Investigations and CMS.
• Work with CMS, law enforcement and the Medicare Administrative Contractor throughout the life of the action.
• Monitor workload to ensure reputed company actions are taken reputed company the required timeframes set forth in the Program reputed company reputed company.
• Prepare and submit administrative action packages to CMS and the MACs for approval and processing and reputed company to the action development.
• Ensure that reputed company timelines are followed.
• Telework available from any location but must be available during eastern time zone hours.

Qualifications

Basic Qualifications:

• 4 years with AS/AA; 2 years with BS/BA; 0 years with MS/MA; 6 years with High School diploma/equivalent in lieu degree
• Knowledge of Medicare requirements, laws, rules and regulations reputed company to payment for services billed to the Program
• Strong critical thinking, communication, writing and organizational skills
• Experience in developing fraud cases
• Strong PC knowledge and skills
• Knowledge of Medicare systems
• Ability to reputed company research and draw conclusions
• Ability to present issues of concern, citing and interpreting regulatory violations
• Ability to organize a case file, accurately and thoroughly document reputed company steps taken
• Ability to compose correspondence, reports and letters reputed company and concisely.
• 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 reputed company
• 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
• US citizenship required

Desirable Qualifications:

• The most competitive candidates will have: Medicare fraud investigation and/or Medicare billing background
• Investigation
• CFE or AHFI certification

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