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Administrative Action Coordinator - Healthcare

Expired Job

Perspecta Inc. Raleigh , NC 27611

Posted 2 months ago

Administrative Action Coordinator

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


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


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
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Administrative Action Coordinator - Healthcare

Expired Job

Perspecta Inc.