Auditor - Healthcare Fraud

Perspecta - Miramar, FL (28 days ago)3.5


Every day at Perspecta, we enable hundreds of thousands of people to take on our nation’s most important work. We’re a company founded on a diverse set of capabilities and skills, bound together by a single promise: we never stop solving our nation’s most complex challenges. Our team of engineers, analysts, developers, investigators, integrators and architects work tirelessly to create innovative solutions. We continually push ourselves—to respond, to adapt, to go further. To look ahead to the changing landscape and develop new and innovative ways to serve our customers. Perspecta works with U.S. government customers in defense, intelligence, civilian, health care, and state and local markets. Our high-caliber employees are rewarded in many ways—not only through competitive salaries and benefits packages, but the opportunity to create a meaningful impact in jobs and on projects that matter. Perspecta’s talented and robust workforce—14,000 strong—stands ready to welcome you to the team. Let’s make an impact together. Perspecta has an immediate need or Medicare Fraud Auditor in Miramar, FL. SafeGuard Services (SGS), a subsidiary of Perspecta, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse. Since 1999, SGS has prevented more than $7.9 billion in inappropriate payments, consisting of over $5.2 billion in proactively Prevented Dollars and $2.7 billion in Recovered Dollars. Our experience with fraud and abuse analytics has resulted in the referral of hundreds of cases to law enforcement and resulted in successful criminal and civil prosecution and civil monetary penalties. Position Overview: The position requires the individual to use a variety of tools to initiate investigations and/or audits, identify subjects and develop cases for future action, including referral to law enforcement, education, over payment recovery and other administrative actions. Will work with internal resources and external agencies to develop cases and corrective actions as well as respond to requests for data and support. Works on problems of moderately complex scope. Acts as an informed team member providing analysis of information and limited project direction input. Exercises independent judgment within defined practices and procedures to determine appropriate action. Evaluates unique circumstances and makes recommendations. This position will require the employee to engage with state counterparts on a consistent and constant basis to coordinate audits, develop audit plans, and report results. • This position may require the incumbent to appear in court to testify about work findings. • 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 • Audits cost reports, claims submissions and performs ad-hoc focused audits. • Identifies inherent and residual risks and conducts risk-based audits. • Develops an understanding of the function to be audited and uses business knowledge, analytical skills and experience in identifying findings and improvements. • Works closely with team members to provide ongoing progress reports and updates of audit findings. • Participates in projects/audits. • Provides research and data analysis for moderately complex projects. • Stays abreast of new audit developments. • Intermediate knowledge of internal audit policies and operating principles. • Intermediate understanding of Medicare/Medicaid or healthcare auditing and their revenue cycles. • Intermediate risk assessment and scoping skills. • Strong research and analytical skills. • Intermediate financial and business acumen. Education and Experience:

  • Must be a US Citizen or a Green Card Holder who has lived in the US 3 of out the past 5 years.
  • Bachelor’s degree in finance, accounting or related field preferred. May substitute 4 years of experience for bachelor’s degree.
  • Typically 2+ years of related experience in finance, accounting or audit.
  • Strong familiarity with Microsoft Office tools, including intermediate to advanced knowledge of Excel
  • Previous Medicaid Integrity Audit experience preferred
  • Strong investigative skills
Strong communication and organization skills
Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases

EEO Tagline: Perspecta is an AA/EEO Employer - Minorities/Women/Veterans/Disabled and other protected categories