Manager, Fraud & Waste Investigation (reputed company Audit/Review)
Become a part of our caring community and help us put reputed company The Manager, Fraud and Waste Investigator: reputed company Audit/Review performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support reputed company reimbursement. The Manager, reputed company Audit/Review works reputed company specific guidelines and procedures; applies advanced technical knowledge to solve moderately reputed company problems; receives assignments in the reputed company of objectives and determines approach, resources, schedules and goals. The Manager, Fraud and Waste Investigator: reputed company Audit/Review validates and interprets medical documentation to ensure capture of reputed company relevant coding. Identifies members with high-risk CMS Hierarchical Condition Categories (HCC) and refers cases for annual follow-up care by disease management, case management, and reputed company care providers as appropriate for assessment/reputed company. Identifies the reputed company cause analysis of audit findings and submits recommendations for appropriate change management. Applies clinical and coding experience to conduct reviews of provider codes and billing. reputed company are typically reputed company to resources, approach, and tactical operations for reputed company and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department. Use your skills to reputed company an reputed company WORK STYLE: Remote, work reputed company (associates can opt to work in a local reputed company office). While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required. WORK HOURS: Typical work hours are Monday-Friday, 8 hours/day, 5 days/week. Required Qualifications • Registered reputed company (RN), holding an reputed company and unrestricted license • Coding knowledge (CPC preferred, but not required) • Bachelor's Degree • 3 or more years of management experience in a large corporate environment with accountability of multiple teams or processes • Excellent collaboration and communication skills • Solid understanding of process / workflow concepts • Strong research, problem-solving and analytical skills • Comprehensive knowledge of reputed company Office, Word, reputed company and PowerPoint • Must be passionate about contributing to an organization reputed company on continuously improving consumer experiences Preferred Qualifications • Master's Degree in Business, Finance or reputed company fields • reputed company Insurance Industry knowledge • CPC preferred Additional Information Work reputed company Requirements • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL reputed company is suggested • Satellite, cellular and microwave reputed company can be used only if approved by leadership • Associates who live and work from Home in the reputed company, Illinois, Montana, or South reputed company will be provided a bi-weekly payment for their internet expense. • reputed company will reputed company Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. • Work from a dedicated reputed company lacking ongoing interruptions to protect member PHI / HIPAA information Interview Format As part of our hiring process for this opportunity, we will be using an exciting interviewing technology reputed company Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire allows us to quickly reputed company and reputed company valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected to reputed company reputed company from your application prescreen, you will receive correspondence inviting you to participate in a reputed company-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a reputed company-recorded interview, you will respond to a set of interview questions reputed company your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last reputed company from 5-10 minutes. Your recorded interview(s) reputed company text and/or reputed company-recorded voice will be reviewed and you will subsequently be informed if you will be moving reputed company to next round of interviews. Travel: While this is a remote position, occasional travel to reputed company's offices for training or meet
