Admin Action Specialist – Medicare

Peraton

. Serve as a point of contact for CMS regarding administrative actions related to investigations .

Posted 11/12/2026full-timeRemote • United StatesMid-LevelSenior💰 $51,000 - $82,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Medicare requirements, administrative actions, and fraud detection while effectively communicating and organizing case documentation. Capable of mentoring team members and ensuring compliance with regulatory standards.

Highest-signal resume keywords

Medicare Requirements KnowledgeFraud Case DevelopmentAdministrative Action ProcessingCFE or AHFI CertificationStrong Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ReviewMedical ReviewEvidence VerificationStatistical MaintenanceWorkflow DevelopmentQuality Control DocumentationResearch and AnalysisCase File OrganizationRegulatory InterpretationTimely Reporting

Soft Skills

Strong Organization SkillsEffective CommunicationMentoringTeam CollaborationProblem Solving

Tools & Technologies

WMMUCM

Certifications & Qualifications

CFEAHFI

Industry Keywords

Program Integrity ManualPayment SuspensionsOverpaymentsFraudWasteAbuseAdministrative ActionsMedicare Administrative ContractorConfidential Material HandlingRegulatory Violations

About the role

Key responsibilities & impact

Serve as a point of contact for CMS regarding administrative actions related to investigations
Provide training and mentoring
Maintain statistics on submitted administrative actions
Maintain template documents used to submit and process administrative actions
Review and verify evidence supporting administrative actions involving payment suspensions, revocations, overpayments and other remedies
Work with investigative teams to ensure documentation supports administrative actions
Coordinate with CMS, law enforcement and the Medicare Administrative Contractor throughout each action
Monitor workload and ensure actions meet Program Integrity Manual timeframes
Prepare and submit administrative action packages to CMS and MACs for approval and processing
Speak to administrative action development
Document QC results in WMM according to record type
Assist with workflow development
Review workloads during monthly meetings, assist with prioritization and conduct staff quality control
Monitor WMM/UCM quality
Monitor timeliness of case updates and escalate to management as necessary
Monitor investigations and cases to ensure all available remedies are used
Mentor team members in identifying previously undetected fraud, waste or abuse through research, analysis and development

Requirements

What you’ll need

2 years with BS/BA; 0 years with MS/MA; 6 years with a high school diploma/equivalent
Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed to the Program
Strong communication and organization skills
Experience in reviewing claims, performing medical review, and/or developing fraud cases
Strong PC knowledge and skills
Ability to attend meetings, training, and conferences; overnight travel may be required
U.S. citizenship required
CFE or AHFI certification (desirable)
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 and 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 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

Benefits

Comp & perks

Medical insurance
Dental insurance
Vision insurance
Life insurance
Health savings account
Short-term disability
Long-term disability
Employee assistance program (EAP)
Parental leave
401(k)
Paid time off (PTO) for vacation
Company-paid holidays
Potential overtime eligibility
Potential shift differential
Discretionary bonus eligibility