PacificSource
Senior Fraud, Waste and Abuse (FWA) Specialist
Boise, ID · Senior
Sponsorship not specified$65k-$111kDetected 1 day ago
ComplianceAuditingHIPAALeadershipCommunicationCollaborationProblem SolvingPublic SpeakingAdaptabilityOrganizational SkillsClaims Management
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odds of building a lasting career here
47Sponsors, lottery-bound
Cap-exempt (no lottery)0
Sponsors this role80
Entry-level history0
PERM / green-card track0
Lottery odds (Level II)66
Fits your clock70
Sponsors, but it's cap-subject — you still face the weighted lottery (~30% per draw at Level II). Good if you win; have a cap-exempt backup on your list.
Lottery odds assume a STEM candidate.
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About the role
- Looking for a way to make an impact and help people?
- Join PacificSource and help our members access quality, affordable care!
- PacificSource is an equal opportunity employer.
Responsibilities
- Support the development and maintenance of the Payment Integrity and FWA program framework.
- Develop, implement, and maintain program policies, workflows, procedures, and controls.
- Maintain centralized tracking and reporting systems for investigations, recoveries, referrals, and regulatory activities.
- Support internal and external audits and corrective action initiatives.
- Collaborate with analytics teams to develop prospective and retrospective monitoring strategies.
- Develop recommendations to improve program effectiveness and financial recoveries.
- Develop and deliver FWA training and awareness programs.
- Perform day-to-day tasks of the compliance department as needed.
- Perform other duties as assigned.
Requirements
- 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.
- Experience with data mining, analytics, regulatory reporting, or collaboration with investigative teams is highly desirable.
- Candidates with an associate's degree and 2 years of relevant experience, or a high school diploma and 4 years of relevant experience, in addition to the required minimum years of work experience will also be considered.
Nice to have
- Experience working with Medicare and/or Medicaid programs preferred.
Skills
- Compensation Disclaimer
- Base Range:
- $65,296.83 - $111,004.62
- 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.
Compensation
- Coordinate annual audit, monitoring, and work plan activities.
Benefits
- Minimum of 5 years of experience in fraud, waste, and abuse (FWA), payment integrity, healthcare compliance, claims auditing, claims analysis, or related healthcare operations functions.
- Experience analyzing healthcare claims data, identifying potential payment integrity risks, and supporting FWA monitoring, reporting, or compliance activities required.
- Education, Certificates, Licenses:
- Bachelor's degree in business, management, health care administration or related field required.
- Working knowledge of fraud, waste, and abuse (FWA) concepts, payment integrity practices, healthcare claims processing, and Medicare and Medicaid requirements.
Company info
- Base Range: $65,296.83 - $111,004.62 Our Values We live and breathe our values.
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