Manager

• Develop, implement and manage strategic fraud, waste and abuse (FWA) activities by maintaining state and federal requirements and monitoring trends/schemes in Ohio and Oklahoma markets
• Develop internal processes for enhanced FWA detection and investigation completion
• Evaluate the department policies and procedures to ensure employee compliance and enhance daily processes
• Prepare the annual audits complying with federal program regulations and participate in CMS audits and new business implementations
• Monitor business processes and systems to assure integrity and compliance in billing and claims payment
• Serve as a lead and investigate all possible fraud, waste and abuse referrals
• Develop customized fraud plans to meet contract and federal requirements
• Review educational materials to identify waste activities as requested by the health plan and on an ad-hoc basis
• Respond to RFP request and implement new policies per contractual obligation
• Attend state and federal meetings as required
• Prepare and distribute monthly and quarterly saving reports
• Performs other duties as assigned
• Complies with all policies and standards

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