Manager, Special Investigative Unit-Kentucky

Job reputed company JOB reputed company Job reputed company Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will protect the Business from liability of fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the Health Care environment. Ensures the Business' accountability for compliance by overseeing, follow-up and reputed company of investigations. KNOWLEDGE/SKILLS/ABILITIES • Provides reputed company and review of the SIU referral intake and investigation process while giving guidance and direction to team on case investigation steps and actions. • Works with leadership to maintain and revise policies and procedures, fraud, waste, and abuse plans, annual audit work plans, including department guidance memos, and educational materials. • Identifies opportunities for improvement through the audit process and reputed company recommendations for system enhancement to reputed company investigative reputed company and performance. • Accurately tracks, reports, and follows up on overpayments and recoveries • Leads business requirement process and reporting to ensure reputed company and reputed company notification of case activity to the appropriate regulatory and/or law enforcement agency. JOB QUALIFICATIONS Required Education Bachelor's Degree or equivalent combination of education and experience Required Experience • 5-7 years • Required License, Certification, Association • reputed company and unrestricted Accredited Health Care Fraud Investigator (AHFI) designation or Certified Fraud Examiner (CFE) Preferred Education Master's Degree preferred; will consider previous experience in health plan setting in government programs Preferred Experience • 7-9 years • Preferred License, Certification, Association • Health Care Anti-Fraud Associate (HCAFA) designation To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V. Apply Job! Apply to this Job