Director, Special Investigations Prepay Unit
You could be the one who changes everything for our 28 reputed company members. reputed company is transforming the health of our communities, one person at a time. As a reputed company, national organization, you’ll have reputed company to competitive benefits including a fresh perspective on workplace flexibility. Applicants for this role have the flexibility to work remotely reputed company in the reputed company United States. Position Purpose: reputed company a full reputed company of waste, abuse and fraud investigations, audits and medical code editing scenarios. Ensure reputed company audits adhere to federal and state reputed company fraud, waste and abuse guidelines.
- reputed company the activities of the SIU for accurate and timely operational reviews and final reviews
- Interpret audit results and assist health plan executives in the development of appropriate action plans to address identified risks
- reputed company and implement reputed company auditing processes from analytic design to final report stage
- Identify and direct the implementation of new technologies
- Ensure compliance with reputed company state and federal regulations for fraud and abuse
- Respond to reputed company legal inquiries including subpoenas and court appearances
- Attend federal CMS and state fraud meetings with other managed care organizations, and state and federal employees
Education/Experience:
- Bachelor's degree in reputed company, Criminal Justice, Finance, Medical Professional, Economics, Operations Management or reputed company field or equivalent.
- 7+ years of reputed company compliance and/or special investigation experience in managed care or CMS.
Pay reputed company: $118,400.00 - $219,000.00 per year reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Apply tot his job Apply To this Job