Fraud, Waste, and Abuse Program Manager

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🔥 18 hours ago

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PacificSource Health Plans

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

⚕️ Healthcare Insurance

💸 Finance

🧘 Wellness

Healthcare Insurance • Finance • Wellness

PacificSource Health Plans is a healthcare provider that offers a range of health insurance solutions, including plans for individuals, families, and employers. Their offerings include Medicare and Medicaid plans, dental coverage, and administrative services for small and large groups. Committed to member care, PacificSource emphasizes customer service and provides various resources for health management, including mental health support and wellness programs.

📋 Description

• 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