Fraud, Waste, and Abuse (FWA) Program Manager
$83,310–$145,793 year
On-siteBend, Oregon, United States
Job Summary
Design, implement, and manage the company's Fraud, Waste, and Abuse (FWA) program by developing policies, procedures, and tracking systems. Chair the Program Integrity Committee to outline annual audit and monitoring plans while proactively researching FWA issues using data mining and analytics to detect outlying claims activities. Maximize recoveries and avoidance for Medicare and Medicaid claims payments through investigative resources and strategies for fraud detection. Serve as the primary point of contact for external oversight agencies including MEDIC and OHA Medicaid Fraud Unit, managing regulatory reporting requirements to CMS and OHA. Present FWA reports to the Audit and Compliance Committee of the Board and assist in developing training presentations.
Required Qualifications
- 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
Desired Qualifications
- Master's degree in business, management, or health care administration preferred
- Fraud examiner certification preferred
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