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Essential Functions:

Work with CMS, law enforcement and the Medicare Administrative Contractor throughout the life of the action Apply federal or state laws to investigations Work with health privacy information, maintain confidentiality and understand all the laws, rules and regulations concerning health privacy Present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government Educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters The position is expected to provide subject matter expertise on investigative strategies for the most highly complex investigations of medical professional service providers. Participate in the coordination of large-scale multi-subject fraud schemes/investigations. and oversee the development of cases for future action, including referral to law enforcement, education, over payment recovery and other administrative actions. Participate in the coordination of projects with

OIG, FBI/DOJ.

Will work with internal resources and senior staff at external agencies to detect and deter emerging fraud schemes Provide strategic direction on stopping program vulnerabilities and deterring fraudulent providers in Medicare and Medicaid Coordinate major cases involving multiple internal and external resources Develop quality processes and training materials Telework available from anywhere in the United States.

Qualifications Required Qualifications:

Minimum of 12 years with a Bachelors degree or 16 years with a HS Diploma. Supervisory experience in the general area of program integrity investigations Experience working with CMS regulations and Medicare claims data require Strong knowledge of Medicare regulations, billing practices, and reimbursement methodologies Experience with fraud detection tools, claims analysis, and data mining technique Sunde Understanding of coding systems (ICD-10, CPT, HCPCS) Excellent analytical, investigative, and problem-solving skills Strong written and verbal communication abilities, including regulatory reporting Ability to manage sensitive and confidential healthcare information (HIPAA compliance) Must be a US Citizen Must be able to obtain and maintain the required agency clearance

Details Target Salary Range:

$86,000 - $138,000. 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 base pay.

Benefits Statement:

Peraton offers eligible employees a variety of benefits including medical, dental, vision, life, health savings account, short/long term disability, EAP, parental leave, 401(k), paid time off (PTO) for vacation, and company paid holidays. A full listing of available benefits can be viewed at https://www.careers.peraton.com/benefits.

Application Statements:

The application period for the job is estimated to be 30 days from the job posting date. However, this timeline may be shortened or extended depending on business needs and the availability of qualified candidates. By applying to this job, you are expressing interest in the role and the Company. During the review of your application, you may be required to participate in an on-camera interview, as well as participate in a process to verify your identity. Use of artificial intelligence (AI) tools of any kind during Peraton interviews is strictly prohibited unless the candidate has obtained prior written authorization. All interview responses must be the candidate's own.

EEO:

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Find & Apply For Criminal Investigator Jobs in Huntsville, Alabama

Fraud Investigative Subject Matter Expert

Special Agent