Claims Audit & FAW Manager

Claims Audit & FAW Manager

Manage and have overall performance accountability for the Corporate Claims Audit & FAW (Fraud, Abuse & Waste) department. Provide Audit, investigation and claims quality solutions to GlobeMed Operations. Responsible for setting-up and Operationalizing the Claims Audit & FAW processes and tools across all Operations.   

Requirements

  • Bachelor’s Degree in Forensic Science, Criminal Justice, Healthcare, or a related field or equivalent experience preferred.
  • Leadership skills, assertive with self-confidence and strong personality
  • 10+ years of Experience in professional liability, legal implications, fraud, insurance contracts, Health Claims Management, medical processes and ICT tools
  • Substantial knowledge of health care fraud and abuse laws and regulations
  • Demonstrated understanding of common fraud schemes and the ability to review and evaluate assigned referrals and apply appropriate investigative strategies as needed.
  • Strong knowledge of standard industry coding guidelines such as CPT, HCPCS, ICD 10 and NCCI.
  • Ability to independently develop and present verbal and written investigative and management reports.
  • Demonstrated business acumen, including the ability to see the 'big picture' as well as the relationship of very detailed and specific business issues