Our national managed care company is seeking a Fraud & Abuse Manager for our SIU (Special Investigations Unit) in our Harrisburg, PA; Louisville, KY; Sunrise, FL; or San Antonio, TX service center location. As a strategic member of the SIU team, this individual will be responsible for managing quality initiatives and programs to ensure compliance for accreditation and federal and state regulatory requirements. Provides oversight and management of fraud and abuse initiatives.
ESSENTIAL RESPONSIBILITIES
•Manages departmental responsibilities to ensure compliance for accreditation, regulatory and/or performance guarantees are being met including, but not limited to oversight of Department of Insurance investigations, surveys, medical transcriptions, subpoenas and data extractions for reporting.
•Manages fraud & abuse investigations to ensure a cost-effective program resulting in fraud identification and recovery.
•Provides support to operational areas to evaluate and resolve concerns associated with clinical and/or claim outcomes. Coordinates resolution of issues presented by participants, providers and/or clients in a timely manner.
•Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions.
•Performs other duties as assigned.
Coventry Health Care, a $12.2 billion Fortune 500 organization, is a national managed health care company with nearly 5.1 million members in all 50 states. At Coventry Health Care, we are driven to ensure that every person and organization we serve receives the greatest possible value for their health care investment. We do this by providing a full range of competitive products through our seven core businesses – Commercial Risk, Medicare Advantage, Medicare Part D, Medicaid, Workers' Comp Services, Federal Employees Health Benefits Plan and Network Rental.
We are committed to constantly improving our low-cost platform so that we can deliver the products and services that our customers want at a price they can afford. Coventry has the expertise, the experience, and the agility to craft the new products, the new processes, and the new service needed to make healthcare more accessible to all Americans.
We offer a competitive salary, excellent benefits (401K with company matching, comprehensive benefits including medical, dental, and tuition reimbursement), vacation and sick time. This is a highly visible role dealing with business partners across the division and corporation, and being a part of motivating a dynamic team!
Qualifications:
- Bachelor’s degree or equivalent experience.
- 7 – 10 years experience in managed care, group health, workers’ compensation and/or insurance, including 5 years experience with health care insurance fraud investigations.
- 1 – 3 years supervisory/managerial experience required.
- Ability to use standard corporate software packages and corporate applications.
Preferred Qualifications:
- Experience in managing cross-functional, self-directed teams.
- Knowledge of health care and/or related products, medical terminology, diagnosis coding, and coordination of benefits.
Other:
- Highly self-motivated and able to work well under stress in a fast-paced environment.
- Strong listening and interpersonal skills; skilled at developing and maintaining effective working relationships.
- Demonstrated leadership and motivation skills.
- Effective verbal and written communication skills.
- Strong analytical and problem-solving skills.
Please apply directly to http://jobs.coventryhealthcare.com and refer to Req#1212494, Mgr, Fraud & Abuse.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team
Job: First/Mid Level Officials and Managers
Primary Location: Harrisburg, PA, US
Other Locations: San Antonio-Texas-United States,Louisville-Kentucky-United States,Scottsdale-Arizona-United States,Sunrise-Florida-United States
Organization: 10750 - Service Center - Central Admin
Schedule: Full-time
Job Posting: 2013-02-25 00:00:00.0
Job ID: 1212494