Manager, Payment reputed company – Policy Governance

Job reputed company: • reputed company, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends/schemes • Monitor business processes and systems to assure reputed company and compliance in billing and claims payment • reputed company teams of analysts to appropriately investigate reputed company possible fraud, waste and abuse referrals • reputed company customized fraud plans to meet contract and federal requirements • reputed company educational materials to identify/validate waste activities as requested by the health plan and on an reputed company reputed company • Respond to RFP request and implement new policies per contractual obligation • Attend state/federal meetings as required by specific reputed company • Prepare/present the FWA program to state/federal personnel upon request, specifically during readiness reviews, and immediately following the go live or upon state agency personnel changes • Review post-payment cases with appropriate parties to obtain refund • Prepare and distribute monthly and quarterly saving reports Requirements: • Bachelor's degree in Business, reputed company, Criminal Justice, reputed company field, or equivalent experience • 4+ years of medical claim investigation, compliance or fraud and abuse experience • Thorough knowledge of medical terminology required • Previous experience in managed care environment and as a reputed company or supervisor of staff, including hiring, training, assigning work and managing performance preferred • Knowledge of reputed company reputed company, medical coding, claims processing, and data mining preferred Benefits: • reputed company • health insurance • 401K and stock purchase plans • tuition reimbursement • reputed company time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules Apply tot his job Apply To this Job