Job Information
DOCTORS HEALTHCARE PLANS, INC. Manager – Fraud, Waste & Abuse in Coral Gables, Florida
Position Purpose: The Manager – Fraud, Waste & Abuse (FWA) is responsible for day-to-day activities of the FWA Program while meeting operational and service requirements in compliance with CMS, AHCA and other regulatory state and federal guidelines.
Key Responsibilities:
Responsible for administering the FWA Program, FWA WorkPlan, and related activities
Detect, investigate and report fraud, waste and abuse cases
Lead special investigations, maintain FWA records, submit to I-MEDIC
Partner with the Internal Audit/Recoveries Unit and other area to help mitigate FWA
Develop and implement corrective action plans; track accomplishment of corrective action plan and area statistics
Educate providers, vendors and members on how to identify and report FWA cases
Ensure compliance with state and federal regulators
Prepare the FWA Quarterly Report for the Compliance Committee
Qualifications:
Bachelor’s degree desired
Minimum 5 years of experience in Medicare Advantage Plans or healthcare industry at large
Proven track record in FWA, special investigations and risk assessment
Knowledge of claims, benefits and provider contracts
Capable of researching complex issues and applying critical thinking
Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.
No Third Party Agencies or Submissions Will Be Accepted.
Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP
Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.
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