Fraud Referral Specialist – Medicare

Responsibilities 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 a Fraud Referral Specialist to our SGS team of talented professionals. What you'll do: The position requires the individual to use a variety of tools to assist in the evaluation of referrals and complaints, as well as development of investigations to identify potential fraud. Development of investigations commonly include responding to referrals from other entities, fielding requests for data and support, analyzing and interpreting claims data for aberrancies, conducting interviews, and reporting findings with a focus on taking quick and appropriate follow up actions. Follow up actions commonly include referrals to field investigative teams or to the data team for further analysis. Perform research and draw conclusions Present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government Organize a case file, accurately and thoroughly document all steps taken Conduct background investigation on providers within the Medicare program Compose correspondence, reports, and referral summary letters Educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters Telework available from Florida Qualifications Basic Qualifications: 0 year