Medicaid Fraud Auditor

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 Medicaid Fraud Auditor to our SGS team of talented professionals. What you'll do : This position requires an individual who can research and interpret federal and state Medicaid requirements, develop appropriate audit procedures, analyze claims and supporting documentation, identify and substantiate exceptions, determine potential overpayments, and clearly communicate audit conclusions. Conduct Medicaid compliance, payment, provider, and focused audits involving a variety of provider types, services, and Medicaid program requirements. Independently perform audit activities from planning and development of audit procedures through testing, analysis, findings, and completion of the audit. Research and interpret federal and state statutes, regulations, Medicaid manuals, provider requirements, policies, and other applicable guidance. Develop audit testing procedures that address identified risks and applicable Medicaid requirements. Analyze Medicaid claims, payment data, medical or service documentation, financial records, provider records, and other information to identify potential noncompliance and improper payments. Determine, calculate, or validate potential Medicaid overpayments using appropriate audit methodologies and supporting docume