Administrative Action Specialist Team Lead

• Minimum of 8 years with BS/BA or 12 years of experience and a HS Diploma.
• 8 years of relevant investigative experience required
• Knowledge of Medicare requirements, laws, rules and regulations related to payment of services billed to the Program
• Medicare claims processing knowledge
• Strong communication and organization skills
• Strong PC knowledge and skills
• US citizenship required
• Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed to the Program
• Experience in reviewing claims, performing medical reviews, and/or developing fraud cases
• CFE or AHFI certification a plus

Essential Functions Include:

• 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
• 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 for the team
• 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 may be required
• Document QC results in WMM according to record type
• Coordinate with other designated leads, if necessary, for coverage for periods where the lead is out of the office during work hours.