Administrative Action Coordinator
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 ourselvesto 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 waysnot 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 workforce14,000 strongstands ready to welcome you to the team. Let's make an impact together.
SafeGuard Services (SGS), a subsidiary of DXC Technology, 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 $9 billion in inappropriate payments, consisting of over $5.6 billion in proactively Prevented Dollars and $3.4 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.
This individual's primary responsibilities include being a Point of Contact for CMS regarding all administrative actions related to investigations. Reviewing and approving all admin action requests prior to submitting to CMS. Providing training and mentoring. Maintaining statistics on all submitted administrative actions. Maintaining template documents used to submit and process administrative actions.
There may be multiple of these individuals for a task order and they may lead significantly different activities
Assist team members with workflow development
Review individual workload during monthly meetings; assist with prioritization and conduct QC for staff
Monitor the quality of WMM/FID
Monitor timeliness for case updates and escalating to management as necessary
Monitor the progress of investigations and cases to ensure use of all available remedies, i.e., suspension, pre-pay reviews, revocation, etc.
Mentor team members so that they can identify previously undetected fraud, waste or abuse through proactive or reactive research, analysis and development.
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
Document QC results in WMM according to record type
Education and Experience Required:
Must be a US Citizen or a Green Card Holder who has lived in the US 3 out of the past 5 years.
At least 5 years of relevant investigative experience required, bachelor's degree preferred
Knowledge and Skills:
Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed the Program
CFE or AHFI certification preferred
Strong communication and organization skills
Experience in reviewing claims, performing medical review, and/or developing fraud cases
Strong PC knowledge and skills
EEO Tagline: Perspecta is an AA/EEO Employer