Procom
Manager Special Investigation
Procom - Houston, Texas, United States, 77092
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Overview
Manager Special Investigation:
On behalf of our healthcare client, Procom is searching for a Manager Special Investigation for a 3 month contract to hire role in Houston, TX 77092
Manager Special Investigation - Job Description: The Manager Special Investigation will oversee the Special Investigations Unit (SIU) and Fraud, Waste & Abuse (FWA) Program, ensuring compliance with contractual and regulatory requirements. The role involves managing case investigations, overpayment recoveries, and reporting to regulatory agencies, while also developing employee education and identifying new recovery opportunities.
Manager Special Investigation - Responsibilities: •Coordinate with subcontractors on overseeing investigations of Fraud, Waste & Abuse (FWA). •Manage a large fraud investigation caseload and investigate allegations related to healthcare fraud. •Provide case updates and recommendations in coordination with SIU team members and other departments. •Interface with members, vendors, and other third parties to further and conclude investigations. •Implement processes to prevent, detect, investigate, and report FWA to regulatory agencies. •Provide inter-departmental input regarding controls for preventing and monitoring FWA issues. •Identify trends and aberrant activity to generate leads for FWA investigations. •Perform special assignments related to FWA as assigned by the Director of Controls and Compliance.
Manager Special Investigation - Mandatory Skills: •Strong analytical and research skills. •Experience in fraud, waste & abuse (FWA) investigations or special investigations unit (SIU). •Knowledge of medical terminology and experience with CPT codes, ICD-9, and ICD-10 coding. •Strong communication and customer service skills. •Certification in CPA, CFA, AHFI, or INT-POPC. •Experience working with Medicaid. •Ability to exercise independent judgment and use technology in investigations.
Manager Special Investigation - Nice-to-Have Skills: •Knowledge of suspected FWA trends and matters of interest to law enforcement and regulators. •Experience with a Health Plan and understanding of SIU components and functions. •Proficiency in identifying information resources. •Problem-solving skills. •Teamwork-oriented mindset.
Manager Special Investigation - Assignment Length: 3 month contract to hire role in Houston, TX 77092
Manager Special Investigation - Start Date: ASAP.
Manager Special Investigation - Assignment Location: Houston, Texas, United States. This position is onsite.
Manager Special Investigation - Job Description: The Manager Special Investigation will oversee the Special Investigations Unit (SIU) and Fraud, Waste & Abuse (FWA) Program, ensuring compliance with contractual and regulatory requirements. The role involves managing case investigations, overpayment recoveries, and reporting to regulatory agencies, while also developing employee education and identifying new recovery opportunities.
Manager Special Investigation - Responsibilities: •Coordinate with subcontractors on overseeing investigations of Fraud, Waste & Abuse (FWA). •Manage a large fraud investigation caseload and investigate allegations related to healthcare fraud. •Provide case updates and recommendations in coordination with SIU team members and other departments. •Interface with members, vendors, and other third parties to further and conclude investigations. •Implement processes to prevent, detect, investigate, and report FWA to regulatory agencies. •Provide inter-departmental input regarding controls for preventing and monitoring FWA issues. •Identify trends and aberrant activity to generate leads for FWA investigations. •Perform special assignments related to FWA as assigned by the Director of Controls and Compliance.
Manager Special Investigation - Mandatory Skills: •Strong analytical and research skills. •Experience in fraud, waste & abuse (FWA) investigations or special investigations unit (SIU). •Knowledge of medical terminology and experience with CPT codes, ICD-9, and ICD-10 coding. •Strong communication and customer service skills. •Certification in CPA, CFA, AHFI, or INT-POPC. •Experience working with Medicaid. •Ability to exercise independent judgment and use technology in investigations.
Manager Special Investigation - Nice-to-Have Skills: •Knowledge of suspected FWA trends and matters of interest to law enforcement and regulators. •Experience with a Health Plan and understanding of SIU components and functions. •Proficiency in identifying information resources. •Problem-solving skills. •Teamwork-oriented mindset.
Manager Special Investigation - Assignment Length: 3 month contract to hire role in Houston, TX 77092
Manager Special Investigation - Start Date: ASAP.
Manager Special Investigation - Assignment Location: Houston, Texas, United States. This position is onsite.