Salary
💰 $118,730 - $295,514 per year
About the role
- Oversight of contract requirements and jurisdictional operations
- Lead, manage, and support a team
- Ensure appropriate staffing and resource allocation
- Maintain effective communication with internal staff and external stakeholders
- Ensure compliance with contract requirements including quality, cost control, and timeliness
- Implement and maintain a quality assurance program
- Submit timely and accurate monthly cost reports and corrective action plans as needed
- Ensure timely and quality submission of deliverables and ad hoc requests
- Maintain superior business relations with CMS, Law Enforcement, MACs, and other partners
Requirements
- Bachelor's degree with 20 years of professional experience OR Master’s degree with 15 years of professional experience
- At least eight years in healthcare, Medicare, Medicaid, or related private insurance field
- Minimum of seven years in a progressive management capacity with responsibility for managing complex systems and workflows
- US Citizenship is required
- Must be able to obtain Public Trust clearance
- Intensive experience conducting and overseeing healthcare fraud investigations for healthcare payers and/or law enforcement
- Customer familiarity with the CMS Center for Program Integrity (CPI)
- Expertise in the Medicare program and the CMS/CPI’s fraud, waste, and abuse workflow
- Credentials such as: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AFHI), or similar
- Proficiency in MS Office Applications (Word, PowerPoint, Outlook, Excel, Project) and MS SharePoint.
- Reasonable Accommodations are available
- Equal Opportunity Employer
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
quality assurancecost controlresource allocationhealthcare fraud investigationsmanaging complex systemsworkflows management
Soft skills
leadershipcommunicationteam managementstakeholder engagementbusiness relations
Certifications
Certified Fraud Examiner (CFE)Accredited Healthcare Fraud Investigator (AFHI)