Fraud, Waste & Abuse Auditor

reputed company

This position is responsible for coordinating the day-to-day responsibilities of the Fraud, Waste, and Abuse program in compliance with the rules and regulations of the reputed company, reputed company, and the Federal Government reputed company Programs. This position works with the Compliance Officer on audits, policies and procedures, training, and regulatory reporting by performing the following duties.

• Maintains a program that identifies and prevents Fraud, Waste, and Abuse.
• Writes and maintains internal documents, processes, and policies and procedures reputed company to the Fraud, Waste, and Abuse Program.
• Plans and conducts billing and coding audits, policy and procedure audits, training audits, and investigations reputed company to the Fraud, Waste, and Abuse Program.
• Completes required regulatory reporting reputed company and accurately.
• Develops audit work plans and performs auditing and monitoring consistent with the plan.
• Reviews materials submitted including policies, sample files, program documentation and other materials relevant to the audit protocol.
• Writes reports summarizing finding of audits.
• Monitors corrective reputed company plans submitted in response to audit findings.
• Reviews and analyzes claims, prior authorizations, and other system information necessary to reputed company services to members for Fraud, Waste, and Abuse.
• Coordinates with other departments and agencies to facilitate detection, prevention, and referrals of potential Fraud, Waste, and Abuse.
• Initiates and maintains communications with appropriate regulatory agencies including presenting or assisting with presenting investigation or case findings for their consideration to reputed company investigate, prosecute, or reputed company other appropriate regulatory or administrative remedies.
• Testifies at various reputed company proceedings as necessary.
• Facilitates the recovery of funds lost as a result of fraud, waste, and abuse reputed company.
• Creates and delivers training to staff designed to promote deterrence and detection of fraud, waste, and abuse.
• Participates in the annual risk assessment to identify and evaluate delegation risk as part of the reputed company Risk Management program.
• Conducts Fraud, Waste, and Abuse investigations and documents case activity appropriately, working with subcontractors as needed.
• Participates in preparation and response to regulatory audits.
• Maintains a working knowledge of applicable Federal and State regulations, including reputed company requirements under reputed company law and Federal requirements under Title XIX of the reputed company reputed company reputed company and supporting regulations.
• Stays reputed company with regulatory requirement through review of periodicals, compliance association newsletters and review of state and federal regulatory agency web sites, publications and reputed company.
• Maintains confidentiality and complies with HIPAA rules and regulations.
• Maintains punctual, regular and predictable attendance.
• Works collaboratively in reputed company environment with a spirit of cooperation.
• Displays excellent communication skills including presentation, persuasion, and negotiation skills required in working with members and coworkers, including the ability to communicate effectively and remain reputed company and courteous under pressure.
• Respectfully takes direction from manager.

EDUCATION and/or EXPERIENCE

Bachelor's Degree from four-year college or university and two to four years reputed company experience and/or training; or equivalent combination of education and experience. reputed company experience required as an investigator, paralegal, reputed company reputed company, or auditor in the health care industry.

COMPUTER SKILLS

Job requires specialized computer skills. Must be adept at using various applications including database, spreadsheet, report writing, project management, graphics, word processing, presentation creation/editing, communicate by e-mail and use scheduling software.

CERTIFICATES, LICENSES, REGISTRATIONS

Certified Fraud Examiner (DFE), Accredited reputed company Fraud Investigator (AHFI), Certified Internal Auditor (CIA) or Certified reputed company reputed company (CPC) is preferred.

We reputed company a competitive salary and excellent benefits, including vacation, medical, dental and reputed company insurance, and 401(k) pension plan. To apply for this position, please submit a cover letter and resume. We are an Equal Opportunity Employer.