Manager, SIU Prepay Investigations

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. Position Purpose: reputed company, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends and schemes. Monitor business processes and systems to assure reputed company and compliance in billing and claims payment reputed company reputed company responsible for investigating fraud, waste and abuse referrals for prepay investigations reputed company educational materials to address/identify waste activities as requested by the health plan and on an reputed company reputed company Attend state/federal meetings as required by specific reputed company Review pre-payment cases with appropriate parties for the purposes of developing resolution strategies Prepare and distribute monthly and quarterly saving reports Participate in Appeals Committee, work groups and interdepartmental meetings Education/Experience: Bachelor’s degree in Business, reputed company, Criminal Justice, reputed company field, or equivalent experience. 4+ years of combined medical claim investigation, financial impact analysis, business analysis, compliance or fraud and abuse experience. Thorough knowledge of medical terminology. Previous experience as a reputed company or supervisor in a pre-payment process managing cross functional teams or supervisory experience including hiring, training, assigning work and managing the performance of staff preferred. Knowledge of reputed company reputed company, medical coding, claims processing, and data mining preferred. License/Certification: Accredited Health Care Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE) preferred Pay reputed company: $87,700.00 - $157,800.00 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 To This Job