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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.
What you'll do:
This position is on the SGS NE UPIC contract supporting Medicaid initiatives across the northeastern jurisdiction. The northeastern jurisdiction includes the following states:
Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, Pennsylvania, Delaware, Maryland, and the District of Columbia.
This individual’s primary responsibilities are to research, understand, and articulate Federal and State regulations and policy as they relate to the administration of the State Medicaid programs for those states within the northeastern jurisdiction. As the subject matter expert, the position will work to gain an understanding of these programs and their respective nuances by state and work with the greater Medicaid team to primarily research and educate in tandem with project development or in response to referrals.
Additional Responsibilities:
Articulate policy/regulations in both a written manner and through discussion/presentation.
Provide a written policy contribution for incorporation into the Analytical Findings Report.
Consult to identify projects in collaboration with the Project Coordination team and the Data team.
Identify potential program vulnerabilities arising out of policy research.
Interact with the states in the jurisdiction to engage in policy discussion.
Interact with CMS to engage in policy discussion.
Keep abreast of emerging issues and developments that have direct impact on the state Medicaid programs within the jurisdiction.
Assist the Medicaid Operations Lead with special research projects as requested.
Ownership of the Medicaid Policies & Procedures Manual to include an annual review to determine if direction is current, which may include needed updates as well as ad hoc updates as direction changes (i.e., internally or by the customer).
Track policy workload and report monthly to the Medicaid Operations Lead.
Oversee state meeting agendas and minutes process in coordination with the Business Analyst.
Position will be Telework available from all states and time zone(s).
Qualifications
Basic Qualifications
5 years with BS/BA or 9 years with a HS Diploma At least 5 years’ experience in policy research and analysis.
Ability to present and discuss state policies and regulations in connection with project impact.
Ability to research policies, interpret regulations and regulatory rules/guidance.
Strong interpersonal skills: ability to work and make decisions independently and in a team environment.
Excellent planning, organizational skills.
Excellent oral and written communications; able to communicate and make presentation to all levels of management and associates at all levels throughout the Company.
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
Ability to adapt to changing priorities, self-motivated and energetic qualities desirable.
Experience using Microsoft Office (Word, Excel, Access, PowerPoint, and Outlook).
US citizenship required
The most competitive candidates will have:
Experience with CMS programs – Medicaid and Medicare.
Experience with Managed Care programs.
Knowledge of CMS regulations related to State Medicaid programs to include waivers.
Knowledge of CMS 64 – analyse and interpret reports to determine trends and vulnerabilities.
Knowledge of Federal Matched Assistance Program to State Medicaid programs.
Medical Coding knowledge/experience related to billing of Medicare/Medicaid claims a plus.
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
