Sorry, this job is no longer accepting applications. See below for more jobs that match what you’re looking for!

Administrative Action Coordinator - Healthcare

Expired Job

Perspecta Inc. Raleigh , NC 27611

Posted 4 months ago

Administrative Action Coordinator

  • Healthcare Apply Job ID 1685322 Location Miramar, Florida, United States; Raleigh, North Carolina, United States Clearance

Description

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.

Position Overview:

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.

Essential Functions:

  • 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

Qualifications

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

  • Minorities/Women/Veterans/Disabled and other protected categories
upload resume icon
See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Fixed Term Administrative Client Support Concierge Raleigh NC

Pwc

Posted Yesterday

VIEW JOBS 1/15/2019 12:00:00 AM 2019-04-15T00:00 A career in Administration and Secretarial Services, within Internal Firm Services, will give you with the opportunity to provide administrative support to PwC employees. You'll focus on using business software applications to prepare reports, receiving and directing incoming calls or emails to the appropriate parties, arranging business travel, tracking expenses, and coordinating meeting arrangements. Responsibilities At the Administrative level, you'll support our engagement teams from strategy to execution. Specific responsibilities include but are not limited to: * Proactively support the market team and provide necessary support to internal teams * Serve as the internal "single point of contact" for administrative needs * Arrange travel, schedule meetings, prepare agendas, and respond to routine correspondence * Maintain records or files and respond to visitors and telephone calls * Provide services in a manner that demonstrates the highest levels of quality, accountability, and teamwork Job Requirements and Preferences: Basic Qualifications: Minimum Degree Required: High School Diploma Minimum Years of Experience: 1 year(s) Preferred Qualifications: Degree Preferred: Bachelor Degree Preferred Knowledge/Skills: Demonstrates some knowledge and/or a proven record of success in the following areas: - Understanding engagement teams business agenda and deadlines, including technology and work tools; - Working with a high degree of independence in managing work, networking/collaborating with firm or client resources, and decision making; - Identifying and addressing client needs, responding to client and/or team requests promptly and professionally, readily offering assistance, and contributing to a positive, collaborative team environment; - Seeking instruction proactively, providing feedback and coaching to develop and improve performance and impact to engagement team; - Working with client related systems and providing guidance/support to both firm and client staff on the usage of those specific systems; and, - Staying abreast of policies, procedures, tools, resources and communicate applicable information to the team. Demonstrates some abilities and/or a proven record of success in the following areas: - Coordinating with client all client background checks (CID), security badge and IT access requests for PwC staff and contractor staff; - Gathering background checks documentation; - Providing monthly reconciliations of software/background checks for teams; - Coordinating maintenance and facilities requests at client sites such as equipment, access, heating, air etc.: - Sending all onboarding documents to new staff and entire profiles in client database; - Updating and monitoring team compliance with client IT requirements and security procedures; - Independence Acceptance & Continuance formatting/tracking for engagement; - Independence Authorization for Services formatting/tracking for engagement; - Maintaining detailed billing plan for engagement and utilizing client's billing system to create and finalize bills; - Central Entity Service (CES) maintenance; - Monitoring budget to actual tracking through Engagement Management Tool (EMT); - Updating and maintaining the fee allocation spreadsheet for engagement; - Meeting management for engagement team; scheduling, room reservations, status updates to client and team; - Maintaining meeting notes and work with engagement team to establish follow-up/action items are captured/communicated; - Assisting with preparation of client deliverables and project management status reports; - Managing Engagement contracts such as Master Service Agreements (MSA), Statement of Work (SOW), Engagement or other contracts; - Providing reprographics support (copying, binding, presentation prep, etc.) to engagement team at client site; - Coordinating team and client meetings and connectivity events; - Coordinating with client EAs to schedule meetings with senior members of management at the client; - Developing and maintaining client relationships; - Informing the client engagement team about process and procedure requirements driven by client; - Maintaining client relationships matrix for scheduling quarterly, annual audit updates and various other meetings; - Updating and distributing team contact list periodically to client; - Coordinating and tracking work between engagement team and Delivery Center(s); and, - Assisting with proposal preparation. All qualified applicants will receive consideration for employment at PwC without regard to race; creed; color; religion; national origin; sex; age; disability; sexual orientation; gender identity or expression; genetic predisposition or carrier status; veteran, marital, or citizenship status; or any other status protected by law. PwC is proud to be an affirmative action and equal opportunity employer. Pwc Raleigh NC

Administrative Action Coordinator - Healthcare

Expired Job

Perspecta Inc.