Senior Fraud, Waste and Abuse Specialist
Job not on LinkedIn
🔥 57 minutes ago
📊 Check your resume score for this job
Improve your chances of getting an interview by checking your resume score before you apply.
📋 Description
• Support the development and maintenance of the Payment Integrity and FWA program framework. • Develop, implement, and maintain program policies, workflows, procedures, and controls. • Maintain centralized tracking and reporting systems for investigations, recoveries, referrals, and regulatory activities. • Coordinate annual audit, monitoring, and work plan activities. • Serve as primary liaison with CMS, MEDIC, OHA, Medicaid Fraud Units, and other oversight agencies. • Ensure timely and accurate submission of FWA and payment integrity reporting requirements. • Monitor regulatory requirements and recommend program enhancements. • Support internal and external audits and corrective action initiatives. • Analyze program performance, recovery results, and fraud prevention outcomes. • Identify fraud schemes, payment vulnerabilities, and emerging risks. • Collaborate with analytics teams to develop prospective and retrospective monitoring strategies. • Develop recommendations to improve program effectiveness and financial recoveries. • Develop and deliver FWA training and awareness programs. • Chair or coordinate Program Integrity Committee activities. • Prepare reports and presentations for leadership, compliance committees, and the Board. • Serve as an internal subject matter expert on FWA and Payment Integrity matters.
🎯 Requirements
• Minimum of 5 years of experience in fraud, waste, and abuse (FWA), payment integrity, healthcare compliance, claims auditing, claims analysis, or related healthcare operations functions. • Experience analyzing healthcare claims data, identifying potential payment integrity risks, and supporting FWA monitoring, reporting, or compliance activities required. • Experience working with Medicare and/or Medicaid programs preferred. • Experience with data mining, analytics, regulatory reporting, or collaboration with investigative teams is highly desirable. • Bachelor's degree in business, management, health care administration or related field required. • Candidates with an associate’s degree and 2 years of relevant experience, or a high school diploma and 4 years of relevant experience, in addition to the required minimum years of work experience will also be considered.
🏖️ Benefits
• Health insurance • 401(k) matching • Flexible working hours • Paid time off • Professional development opportunities
Apply NowSimilar Jobs
🔥 58 minutes ago
Senior Fraud, Waste and Abuse (FWA) Specialist at PacificSource providing expertise in fraud prevention and healthcare compliance. Develop and maintain Payment Integrity programs for the organization.
🔥 58 minutes ago
Senior Fraud, Waste and Abuse Specialist at PacificSource improving payment integrity and fraud prevention in healthcare. Collaborating with teams for regulatory reporting and audit management.
🕒 June 24
Card Fraud Specialist monitoring real-time transaction data for fintech clients. Investigating and classifying fraud while managing disputes responsibly and accurately.
