Complaints/Referrals Team Lead - Medicare
责任安全护卫服务 (SGS),是佩拉顿子公司的子公司，执行数据分析，调查和医疗审查以检测，预防，阻止，减少和提交传递来恢复欺诈，浪费和滥用。我们希望将投诉/推团队领导加入我们的 SGS 团队有才华的专业人士。你会做什么：作为一个调查团队负责人，这个个人的主要职责包括实现质量目标，工作负载监督促进及时开发和解决调查和案例的发展，并向执法部门或其他实体转让，并提供导师和指导给调查团队。个人在广泛定义的政策和实践中，以确定完成工作和实现目标的最佳方法，特别是分析和审查收到的推和投诉。·作为管理者联系点；·协助团队成员进行推背景，分析和工作流程开发；·每月会议期间评估个人的工作负载；帮助优先级化和对员工进行 QC; ·监督 UCM/WMM 质量；监测情况更新及时性；必要时将推和申诉视为指导和调查。·监督投诉和转让的进展，以确保使用所有可用的补救措施，将其转移到现场调查，并提出进一步审查建议 · 导师团队成员以便通过积极或反应性研究，分析和开发来识别以前未发现的欺诈，浪费或滥用。· 从 AL,FL,GA,NC,SC,TN,VA,WV 资格提供远程工作基本资格：· 8年拥有 BS/BA 或12年的 HS 证书经验 ·至少需要5年的相关调查经验。·强大的沟通和组织技能 ·强大的领导背景 ·强有力的 PC 知识和技能 ·美国公民身份要求 需要的资格：最具竞争力的候选人将拥有：·与医疗保险费用支付相关法律，规则和法规知识 · 在开发引擎和调查，进行详细背景分析和链接分析，审查索赔数据，做医学评估或制定欺诈案件方面的经验
查看英文原文
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.
We are looking to add a Complaints/Referrals Team Lead to our SGS team of talented professionals.
What You’ll do:
As an Investigative Team Lead, this individual’s primary responsibilities include achieving quality objectives, workload oversight to promote timely development and resolution of investigations and development of cases for referral to law enforcement or other entities and provide mentoring and guidance to investigative team. The individual exercises significant independent judgment within broadly defined policies and practices to determine the best method for accomplishing work and achieving objectives, specifically in the analysis and review of referrals and complaints that are received.
- Act as a point of contact for manager
- Assist team members with referral background, analysis, and workflow development
- Review individual workload during monthly meetings; assist with prioritization and conduct QC for staff
- Monitor the quality of UCM/WMM
- Monitor timeliness for case updates and prioritize referrals and complaints as leads and investigations as necessary
- Monitor the progress of complaints and referrals to ensure use of all available remedies, transfer to field investigations, and make recommendations for further review
- Mentor team members so that they can identify previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development.
- Telework available from AL, FL, GA, NC, SC, TN, VA, WV
Qualifications
Basic Qualifications:
- 8 years with a BS/BA or 12 years of experience with a HS Diploma
- At least 5 years of relevant investigative experience required.
- Strong communication and organization skills
- Strong leadership background
- Strong PC knowledge and skills
- U.S. citizenship required
Desirable Qualifications:
The most competitive candidates will have:
- Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed the Program
- Experience in developing leads and investigations, conducting detailed background and link analysis, reviewing claims data, performing medical review, and/or developing fraud cases
Essential Functions:
- 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 mentor and train others
- 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
Peraton Overview
Peraton is a next-generation national security company that 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, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can’t be done by solving the most daunting challenges facing our customers. Visit peraton.com to learn how we’re keeping people around the world safe and secure.
Target Salary Range
$66,000 - $106,000. 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.EEO
EEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.Originally posted on Himalayas