Technical Project Management, Senior Advisor

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

Requirements:

• 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