PacificSource

Fraud, Waste, and Abuse (FWA) Program Manager

Springfield, OR

Sponsorship not specified$83k-$146kDetected 8 days ago

ComplianceHIPAALeadershipCommunicationCollaborationProblem SolvingPublic SpeakingAdaptabilityOrganizational Skills

About the role

In collaboration with the Corporate Compliance Officer and other business unit leaders, build and maintain a structure around an FWA and payment integrity program supported by policies, processes, procedures, workflows, and technology.
Develop and maintain FWA policies and procedures and implement a comprehensive FWA program.
Develop and maintain an FWA log and tracking system.
Work to develop prospective and retrospective fraud and abuse detection, investigation, recovery and avoidance through the use of data sources for data mining and analytics to proactively seek out outlying claims activities and investigate for fraud, waste, and abuse.
Develop, translate, and execute strategies or functional/operational objectives for the company with regard to fraud, waste, and abuse.
Manage and oversee the preparation and submission of FWA regulatory reporting requirements to CMS and OHA.
Perform day-to-day tasks of the compliance department as needed.
Perform other duties as assigned.
Ability to build a program from the ground up by developing people, process, and technology mechanisms to support the program.

Ability to read and comprehend both written and spoken English.
It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position.
Ability to gain a thorough understanding of PacificSource compliance initiatives.
Ability to organize large projects that involve working with multi-functional teams under strict deadlines.
Ability to communicate effectively with all levels of the organization both verbally and in writing.
Experience with regulatory agency reporting and interaction as it relates to fraud, waste, and abuse.
Minimum 4 years of related experience with Medicare and/or Medicaid programs required.

Compensation Disclaimer
Base Range:
$83,310.45 - $145,793.28
The wage range provided reflects the full range for this position.
Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity.

The wage range provided reflects the full range for this position.
The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage.
Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity.
Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range.
Chair the Program Integrity Committee and collaborate on the development of the annual work plan which will outline and detail the annual FWA audit and monitoring plan.

Minimum of 8 years related experience in fraud, waste, and abuse investigations, payment integrity processes, and data mining and analysis of health care claims.
Minimum of 4 years of experience implementing or maintaining a fraud, waste, and abuse and payment integrity program in health care.
Bachelor's degree in business, management, health care administration or other related field or Associate's degree and equivalent work experience required.
Master's degree in business, management, or health care administration preferred.

We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.

This listing is sourced directly from PacificSource's careers page and normalized into a canonical job model.