Fraud, Waste, and Abuse Program Manager
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Job Description
FWA Program Manager at PacificSource implementing and managing fraud prevention strategies. Responsible for ensuring compliance with FWA regulations, reporting, and training.
Responsibilities:
- The FWA Program Manager will be primarily responsible for the design, implementation, and management of the company’s FWA Program, providing expertise to staff in developing processes for tracking, investigating, and managing suspected FWA complaints.
- The role will analyze, report and monitor the FWA prevention efforts and provide recommendations to leadership on matters related to FWA compliance.
- The program manager will track and report company activities to ensure compliance with state and federal FWA requirements.
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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