Fraud and Abuse Manager
Job Summary
Managing strategic fraud, waste, and abuse activities, the full-time Fraud and Abuse Manager will develop and implement compliance initiatives while leading teams to investigate referrals and monitor billing processes remotely.
Key responsibilities
- Monitor business processes to ensure integrity and compliance in billing and claims payment
- Lead teams of analysts in investigating fraud, waste, and abuse referrals
- Develop and present educational materials and customized fraud plans to meet contract and federal requirements
Required qualifications
- Bachelor's degree in Business, Healthcare, Criminal Justice, or a related field, or equivalent experience
- 4+ years of experience in medical claim investigation, compliance, or fraud and abuse
- Thorough knowledge of medical terminology
- Previous experience in a managed care environment, preferably in a lead or supervisory role
- Medical records or coding license preferred
Complete Job Description
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