What are the responsibilities and job description for the Manager – Fraud, Waste & Abuse position at Doctors HealthCare Plans, Inc.?
Position Purpose: The Manager – Fraud, Waste & Abuse (FWA) is responsible for day-to-day activities of the FWA Program while meeting operational and service requirements in compliance with CMS, AHCA and other regulatory state and federal guidelines.
Key Responsibilities:
No Third Party Agencies or Submissions Will Be Accepted.
Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP
Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.
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Key Responsibilities:
- Responsible for administering the FWA Program, FWA WorkPlan, and related activities
- Detect, investigate and report fraud, waste and abuse cases
- Lead special investigations, maintain FWA records, submit to I-MEDIC
- Partner with the Internal Audit/Recoveries Unit and other area to help mitigate FWA
- Develop and implement corrective action plans; track accomplishment of corrective action planand area statistics
- Educate providers, vendors and members on how to identify and report FWA cases
- Ensure compliance with state and federal regulators
- Prepare the FWA Quarterly Report for the Compliance Committee
- Bachelor’s degree desired
- Minimum 5 years of experience in Medicare Advantage Plans or healthcare industry at large
- Proven track record in FWA, special investigations and risk assessment
- Knowledge of claims, benefits and provider contracts
- Capable of researching complex issues and applying critical thinking
No Third Party Agencies or Submissions Will Be Accepted.
Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP
Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.
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