Fraud Prevention Manager
Job Summary
Managing strategic fraud, waste, and abuse activities, the full-time remote Fraud Prevention Manager will oversee compliance in billing and claims payment, lead investigative teams, and develop customized fraud plans to meet regulatory requirements.
Key responsibilities:
- Monitor business processes and systems to ensure integrity and compliance in billing and claims payment
- Lead teams of analysts to investigate fraud, waste, and abuse referrals effectively
- Prepare and present the fraud, waste, and abuse program to state and federal personnel as required
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 preferred
- Medical records or coding license preferred
Complete Job Description
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