Senior Program Manager, Provider Operations
Interwell HealthSalary not specified
- Full Time
- Senior (5 to 8 years)
Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare & MedicaidIndustries
Requirements
Candidates must be an Oklahoma resident with at least 23 years of healthcare fraud investigations and auditing experience, strong organizational and interpersonal skills, and an inquisitive nature with the ability to analyze data to metrics. Proficiency in Microsoft Office (Word, Excel, etc.) and strong personal and professional ethics are also required. Any applicable certifications such as Clinical Certifications, CPC, CCS, or CFE are preferred.
Responsibilities
As the Senior Fraud & Waste Investigator, the candidate will carry out the provisions of the compliance plan, including FWA policies and procedures, investigate allegations of FWA, implement corrective action plans, assess records, and refer suspected cases to the Oklahoma Health Care Authority (OHCA) and other enforcement agencies. They will coordinate across departments, oversee internal investigations, collaborate with the Contract Compliance Officer and Compliance Officer, respond to FWA questions and concerns, cooperate with investigative agencies, and assist in developing FWA education. Additionally, they will serve as the primary point of contact for OHCA and other agencies, and oversee the monitoring and enforcement of the fraud, waste, and abuse (FWA) compliance program.
Skills
Fraud Investigation
Compliance Program Oversight
FWA Policies and Procedures
Record Assessment
Inter-agency Coordination
Investigation and Corrective Action
Contract Compliance
Regulatory Knowledge (State and Federal)
Humana
Health insurance provider for seniors and military
About Humana
Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.
Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees