Project Coordinator

Basic Qualifications: 5 years with BS/BA; or 9 years with a HS Diploma/equivalent Healthcare policy and regulation experience (Medicaid preferred). Strong research skills. Strong communication and organization skills. Strong writing skills. Strong computer skills including Microsoft Access, experience in relational data base design, extract, and reporting, Excel, and the Internet Strong proven analytical ability and basic knowledge of statistics and sampling techniques Proven Ability to work with a variety of systems, sources of data and analytic tools Excellent organizational and communication skills US. citizenship required The most competitive candidates will have: Ability to perform research and draw conclusions. Ability to interpret data, policy relative to an allegation. Ability to manage several projects at a time while meeting deadlines with a quality work-product. Ability to work as a liaison across teams, State Medicaid Agencies and CMS in order to identify high priority projects; prioritize the work; and manage the development of the various components that make up the final work-product. Ability to present findings/issues of concern, citing regulatory violations in connection with compliance issues or fraud schemes to defraud State and Federal Government agencies. Ability to compose correspondence and reports. 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. 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 Project Coordinator to our SGS team of talented professionals. What You’ll do: The Project Coordinator will play a pivotal role in supporting the Medicaid Managed Care audit initiative by bridging the gap between business needs and technical solutions. This position requires a unique blend of project management expertise, data strategy development, and technical knowledge of methodologies and algorithms to ensure audit-related data is validated, reliable, and actionable. Leads projects resulting from the discovery of situations that potentially involve fraud, waste or abuse in Medicaid. Develop project methodologies arising out of the project idea including coordinating with internal teams to develop projects. Utilize data analysis techniques to detect aberrancies in Medicaid claims data and proactively seek out and develop leads received from a variety of sources (CMS, OIG, State Program Integrity, MFCU, fraud alerts). Assist in the review of claims history/provider files to determine provider billing patterns and to detect potential fraudulent or abusive billing practices or vulnerabilities in Medicaid policies and initiate appropriate action. Make potential fraud determinations by utilizing internal guidelines, Medicaid provider manuals, Medicaid regulations, and the Social Security Act. Identify Fraud alerts and program vulnerabilities for submission to CMS; share information on current fraud investigations with other Medicaid contractors, law enforcement, and other applicable stake holders. Track and report Medicaid project progress internally and ad hoc to CMS and the States. Coordinate work flow from project to lead stage. Continuous communication with other UPICs for potential project development. Review and provide support and respond to requests for information from Medicaid stake holders as assigned. Telework available from anywhere in the US #J-18808-Ljbffr Peraton