Managing strategic fraud, waste, and abuse activities, the full-time remote Fraud Prevention Manager will oversee compliance in billing and claims payment, lead investigative teams, and develop customized fraud plans to meet regulatory requirements. Key responsibilities: Monitor business processes and systems to ensure integrity and compliance in billing and claims payment Lead teams of analysts to investigate fraud, waste, and abuse referrals effectively Prepare and present the fraud, waste, and abuse program to state and federal personnel as required Required qualifications: Bachelor's degree in Business, Healthcare, Criminal Justice, or a related field, or equivalent experience 4+ years of experience in medical claim investigation, compliance, or fraud and abuse Thorough knowledge of medical terminology Previous experience in a managed care environment preferred Medical records or coding license preferred
Fraud Prevention Manager in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.