Fraud, Waste, and Abuse Program Manager
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Job Description
FWA Program Manager at PacificSource overseeing fraud prevention efforts and compliance with health care regulations. Design and manage comprehensive FWA programs while collaborating with compliance officers.
Responsibilities:
- Design, implement, and manage the company’s FWA Program.
- Provide expertise to staff in developing processes for tracking, investigating, and managing suspected FWA complaints.
- Analyze, report and monitor the FWA prevention efforts and provide recommendations to leadership.
- Track and report company activities to ensure compliance with state and federal FWA requirements.
- Build and maintain a structure around an FWA and payment integrity program supported by policies, processes, procedures, workflows, and technology.
- Develop and maintain FWA policies and procedures and implement a comprehensive FWA program.
- Chair the Program Integrity Committee and collaborate on the development of the annual work plan.
- Develop and maintain an FWA log and tracking system.
- Proactively and independently research FWA issues and effectively employ investigative resources/techniques.
- Maximize recoveries and avoidance for Medicare and Medicaid claims payments.
- Develop disclosure strategies for potential fraud activities to various agencies.
Requirements:
- Minimum of 8 years related experience in fraud, waste, and abuse investigations, payment integrity processes, and data mining and analysis of health care claims.
- Minimum of 4 years of experience implementing or maintaining a fraud, waste, and abuse and payment integrity program in health care.
- Experience with regulatory agency reporting and interaction as it relates to fraud, waste, and abuse.
- Minimum 4 years of related experience with Medicare and/or Medicaid programs required.
- Bachelor's degree in business, management, health care administration or other related field or Associate’s degree and equivalent work experience required.
- Fraud examiner certification preferred.
Benefits:
- Flexible telecommute policy
- Medical, vision, and dental insurance
- Incentive program
- Paid time off and holidays
- 401(k) plan
- Volunteer opportunities
- Tuition reimbursement and training
- Life insurance
- Options such as a flexible spending account
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