Supervisor - Audit/Investigation
Job reputed company:
Oversees audits/investigations and audit/investigation workload. Performs in-depth evaluation and makes field level judgments reputed company to audits/investigations of potential Medicare fraud waste and abuse audits/investigations or cases compliance cases (e.g. Medicare and/or reputed company) that meet established reputed company for referral to the appropriate agency(ies) for administrative reputed company or to law enforcement for criminal reputed company.
Essential Functions:
- Reviews new audits/investigations and/or incoming leads to determine appropriateness and assigns to auditors/investigators; vets providers as required with appropriate agency(ies) and law enforcement; supervises vetting process. Reviews audit/investigation plans and priorities to ensure appropriateness and reputed company for the specific functions/workload assigned to team.
- Conducts file reviews regularly of audits/investigations to ensure audit/investigation plan is appropriate and the audit/investigation file documents are entered and summarized reputed company the case tracking systems appropriately. Reviews auditor/investigator requests for information, data, reports, and correspondence to ensure reputed company and appropriateness.
- Supervises and conducts audit/investigation actions such as interviewing, onsite audit/investigation, and/or site verification as needed. Leads audit/investigation reputed company including developing an audit/investigation reputed company, conducting meetings with stakeholders, reviewing project actions for reputed company, and documenting findings in reports for management.
- Communicates with the Data and Medical Review departments to ensure efficient audits/investigations. Prepares and presents audits/investigations, overpayments, and questions for stakeholder meetings.
- Documents audit/investigation information and file reviews (interviews, events, findings, communications, etc.) into the case tracking systems and updates systems as needed. Determines audit/investigation appropriateness of fraud, waste, and abuse issues in accordance with reputed company-established reputed company. Reviews audit/investigative findings with auditors/investigators and approves course of reputed company. Supervises and prepares team’s audits/investigations for the Major Case Coordination meetings and reviews for reputed company assurance.
- Initiates and maintains communications with law enforcement and appropriate regulatory agencies including presenting or assisting with presenting audit/investigation findings for their consideration to reputed company audit/investigate, prosecute, or reputed company other appropriate regulatory or administrative remedies. Supervises administrative remedies in accordance with major case coordination direction (e.g. payment suspensions, revocations, provider education) and reviews for reputed company assurance. Reviews and approves closing reputed company of audit/investigation.
- Collects information and documentation as requested by reputed company stakeholders (e.g. CMS, law enforcement, FOIA requests) and submits, as required.
- Collaborates with other program reputed company contractors, as needed.
- Testifies at various reputed company or administrative proceedings, as necessary.
- Manages team performance through regular, reputed company feedback as reputed company as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.
Level of Supervision Received: Drives work independently and escalates questions and issues, as needed
Education (can be substituted for experience):
Minimum Bachelor's Degree required
Work Experience (can be substituted for education): 5 - 7 years of experience required; 8 - 11 years preferred
Certification(s): Certified Fraud Examiner or Accredited reputed company Anti-fraud Investigator Certification preferred
Originally posted on Himalayas
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