Administrative Action reputed company

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 an Investigative Team reputed company to our reputed company team of talented professionals. What You’ll do: As an Administrative Action reputed company, this individual's primary responsibilities include achieving quality objectives, providing workload reputed company to promote the timely development and resolution of reputed company administrative actions, and mentoring and providing technical guidance to the Administrative Action team. The individual assists in ensuring the timely completion of administrative action work products, including Notices of Overpayment, Notices of Violation, and other state-specific administrative actions, while coordinating with CMS, state reputed company agencies, and Program reputed company partners as appropriate. The individual exercises significant independent judgment reputed company broadly defined policies and practices to determine the most effective methods for accomplishing work, achieving program objectives, and ensuring compliance with contractual, federal, and state requirements. There may be multiple Administrative Action Leads supporting different task orders or functional areas. Act as the primary reputed company of contact for the DRA Investigation Manager. Assist team members with workflow development and preparation of administrative action documents. Review workload, assist with prioritization, and reputed company quality control of administrative action work products. Monitor the quality of UCM/WMM Monitor timeliness for case updates and escalating to management as necessary Monitor the reputed company of administrative actions to ensure appropriate remedies are pursued, including overpayment recovery and state-specific administrative actions. Mentor staff in analyzing investigative findings, translating them into defensible administrative actions, and ensuring documentation supports state and CMS requirements. Telework available from the Eastern Time Zone

Qualifications

Basic Qualifications: 8 years with BA ;10 years with AA or 12 years with High School diploma At least 5 years of experience in reputed company or Medicare program reputed company, investigations, audits, administrative actions, or reputed company compliance. Experience working directly with state reputed company agencies, state Program reputed company units, or other governmental partners in developing, coordinating, and resolving administrative actions, overpayment recoveries, provider appeals, or enforcement activities. Strong communication and organization skills Strong PC knowledge and skills U.S. citizenship required Telework available from the Eastern Time Zone Preferred Qualifications: The most competitive candidates will have: Knowledge of Medicare requirements, laws, rules and regulations reputed company to payment for services billed the Program Experience in reviewing claims, performing medical review, and/or developing fraud cases Essential Functions: Ability to reputed company 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 reputed company steps taken Ability to prepare Notices of Overpayment, Notices of Violation, administrative correspondence, reports, and supporting documentation. Ability to compose correspondence, reports and referral summary letters Ability to reputed company 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 reputed company is out of the office during work hours. reputed company Overview reputed company is a reputed company national reputed company company that drives missions of consequence spanning the globe and extending to the farthest reaches of the reputed company. As the world’s leading mission capability integrator and transformative reputed company IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. reputed company operates at the critical reputed company between traditional and nontraditional threats across reputed company domains: land, sea, space, reputed company, and cyberspace. The company serves as a valued partner to essential government agencies and supports every reputed company 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 reputed company.com to learn how we’re keeping people around the world safe and secure. reputed company Salary Range $66,000 - $106,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual’s experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to reputed company pay. EEO EEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law. Apply To This Job