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Peraton Corporation Fraud Manager - Medicaid in Jefferson City, Missouri

Peraton Overview

Peraton drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world’s leading mission capability integrator and transformative enterprise IT provider, we deliver trusted and highly differentiated national security solutions and technologies that keep people safe and secure. Peraton serves as a valued partner to essential government agencies across the intelligence, space, cyber, defense, civilian, health, and state and local markets. Every day, our 22,000 employees do the can’t be done, solving the most daunting challenges facing our customers.

We are an Equal Opportunity/Affirmative Action Employer. We consider applicants without regard to race, color, religion, age, national origin, ancestry, ethnicity, gender, gender identity, gender expression, sexual orientation, marital status, veteran status, disability, genetic information, citizenship status, or membership in any other group protected by federal, state, or local law.

As a government contractor, Peraton abides by the following provision

Pay Transparency Nondiscrimination Provision

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of the other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c).

Qualifications

Prerequisites:

This position requires proven leadership skills and in-depth knowledge of State Medicaid Programs as it pertains to reviewing claims and provider behavior for finding indications of potential fraud, waste and abuse. As no two State Medicaid Programs are alike, the position requires a working knowledge of State Medicaid Programs as they relate to regulation hierarchy (i.e., federal & state regulations related to Medicaid) as well working knowledge of Managed Care Organization within the Medicaid environment. Requires excellent organizational, written and communications skills as well as strong PC skills.

Essential Functions:

  • BS 8-10, MS 6-8, PhD 3-5

  • Knowledge of State Medicaid requirements, laws, rules and regulations related to payment for services billed the Program

  • Ability to establish goals, objectives and plans for the unit

  • Ability to motivate staff and evaluate performance

  • Ability to plan resources to address workload needs, set priorities and report unit activity

  • Ability to develop, administer, and control a budget

  • Ability to administer compensation and other corporate polices

  • Ability to recruit and develop staff

  • Ability to effectively work independently and as a member of a team

  • Preferred that selected candidate reside in one of these states, PA, NY, NJ, MD, MA, CT, NH, RI, DC, ME, DE

  • Minimum of five years of relevant leadership or managerial experience is preferred.

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.

Since 1999, SGS has prevented more than $9.65 billion in inappropriate payments, consisting of nearly $5.98 billion in proactively Prevented Dollars and more than $3.69 billion in Recovered Dollars. Our experience with fraud and abuse analytics has resulted in the referral of thousands of cases to law enforcement and resulted in successful criminal and civil prosecution and civil monetary penalties.

Position Overview:

This position entails providing direction to a Medicaid Investigations & Audit team to identify, research, investigate and resolve issues of potential fraud, waste and abuse. Primary responsibilities include oversight and assistance to the development of audits as well as cases for referral to law enforcement or other entities and support for existing casework.

For Colorado Residents

Colorado Salary Minimum: $60,673.60

Colorado Salary Maximum:$129,729.60

The estimate displayed represents the typical salary range for this position, and is just one component of Perspecta's total compensation package for employees. Other rewards may include annual bonuses, short- and long-term incentives, and program-specific awards. In addition, Perspecta provides a variety of benefits to employees.

Job Locations US

Requisition Post Information* : Posted Date 1 month ago (5/13/2021 9:59 AM)

Requisition ID 2021-105305

Position Category Investigation

Clearance No Clearance Required

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