Note: The job is a remote job and is open to candidates in USA. Peraton is a national security and enterprise IT company delivering mission-critical solutions and technologies for government agencies and the U.S. armed forces. The Technical Project Management Senior Advisor will serve as the healthcare program-integrity and fraud, waste, and abuse subject-matter expert for an agentic AI proof of concept supporting CMS, guiding use-case selection, ground-truth curation, and analyst adoption. The role will evaluate AI-generated outputs, align tools with investigator workflows, and collaborate with AI engineers and stakeholders.
Responsibilities
- Serve as the healthcare program-integrity and FWA subject-matter authority on the AI tool assessment project within FPS
- Drive FWA use-case selection for the POC, prioritized by fraud impact and analyst value
- Define and curate ground-truth datasets (known-bad-actor sets, adjudicated case outcomes, referral/enforcement outcomes) used to evaluate AI-generated leads and case files
- Shape analyst-facing use of Peraton[X] (Peraton’s AI tool) and Rapid FI (Fraud Intelligence) so generated leads, dashboards, and case files match real UPIC/MEDIC/MFCU/FDOC investigator workflows
- Evaluate AI-generated outputs for factual, clinical, and procedural accuracy; represent the analyst voice back to engineering
- Partner with the Fraud Signals AI Engineer to validate Babel Street correlations against known fraud patterns, and with the Peraton[X] Support SME on user onboarding and training material
Skills
- Minimum of 12 years with BS/BA; Minimum of 10 years with MS/MA; Minimum of 7 years with Ph.D
- 5+ years working with Medicare and/or Medicaid claims data in a program-integrity, audit, investigative, or fraud-analytics role
- Deep knowledge of healthcare FWA patterns: billing schemes, coding manipulation, identity/beneficiary fraud, provider collusion, DME/home-health/hospice/prescription typologies
- Direct experience inside the CMS program-integrity ecosystem: UPICs, MEDICs, MFCUs, HHS-OIG, DOJ, and Federal/State task-force coordination
- Demonstrated ability to define and curate ground-truth datasets or investigative reference sets used to evaluate fraud-detection outputs
- Ability to translate investigator and analyst workflows into use cases and acceptance criteria for analytics or AI teams
- Familiarity with FPS, IDR, One PI, UCM, or comparable CMS PI systems and their outputs (provider-risk scores, ASRs, model alerts, NCD policy references), enough to interpret them, not to build them
- Comfort partnering with AI/analytics engineers without needing to write code — the SME provides domain judgment, not implementation
- Excellent written and verbal communication; comfortable representing findings to CMS stakeholders and law-enforcement partners
- US citizen with the ability to obtain a Public Trust clearance
- Certified Fraud Examiner (CFE) credential
- Prior work with UPICs, MEDICs, CPS, OIG, DOJ, or as a CMS analyst
- Hands-on experience with SAP BusinessObjects (Web Intelligence) on Medicare/Medicaid universes, plus SAS, Snowflake/Snowsight, or Databricks
- Exposure to agentic AI / LLM analyst tools and comfort using them to accelerate lead review and case building
- Familiarity with T-MSIS and cross-state Medicaid data
- Clinical, coding (CPT/HCPCS/ICD-10), or nursing background
- Experience authoring analyst training material, job aids, or short training modules
Benefits
- Remote work allowed 100%
- Employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.
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