The Medicaid - Medicare Remedy Program Integrity Supervisor will primarily be responsible for activities related to fraud investigation development, support for law enforcement, and ensuring Program Integrity Analysts provide support of post-referral cases.
In assuming this position, you will be a critical contributor to meeting CoventBridge Group's objective: To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse.
This position will report directly to the Program Integrity Manager or PI Project Manager and will work in our Grove City, OH office or if not local, remotely from a home office.
Responsible for activities related to fraud investigation development, support for law enforcement, and ensuring Program Integrity Analysts provide support of post-referral cases
Oversee the day-to-day operations of PI staff
Responsible for prioritization and assignment of workload, ensuring adherence to task order policies and procedures
Work with investigators to develop plans of action for investigation development and information request processing
Meet quality and production standards
Produce and submits required reports according to pre-established time guidelines
Monitor security of evidence gathered during the development of fraud investigations
Help establish and maintain relationships with outside law enforcement agencies
Work closely with the Data Analysts to identify and develop proactive fraud leads through investigation of identified leads
Ensure departmental compliance with Quality Management System and ISO requirements
Responsible for the aggressive application of administrative actions during investigation development (including overpayment identification, payment suspension, referral for civil monetary penalties)
Hire and manage PI staff
Responsible for the timely completion of annual employee performance assessments and, when necessary, employee counseling
Conduct matrix review meetings with investigators to ensure thorough and timely fraud investigations in accordance with task order guidelines
Perform other duties as assigned by the Manager that contribute to task order goals and objectives
Minimum of two (2) years of experience in Medicare fraud investigations including investigation development, data analysis, and problem identification or one (1) year of experience with an advanced degree
Strong knowledge of CMS administrative actions.
Candidates with Certified Fraud Examiner (CFE) Certification will be given priority consideration.
Excellent oral, written and verbal skills.
Ability to work independently and with minimal supervision.
Strong attention to detail.
Able to effectively communicate with external stakeholders.
Manage a high volume workload with quick turnaround times.
Knowledge of statistics, data analysis techniques, and PC skills are preferred.
Must have and maintain a valid driver’s license issued by the state of residence.
Telecommuting is allowed.
Additional Salary Information: Benefits:
Medical, Dental, Vision plans
Life, LTD and STD paid by the employer
401(k) with company match up to 4%
Paid Time Off and company paid holidays
Tuition assistance after 1 year of service
Internal Number: 2019-2185
About Coventbridge Group
CoventBridge Group is the leading worldwide full-service investigation solutions company providing: Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs. With offices in the UK and U.S. the company provides top tier data privacy and security practices, deploys robust case management technology customized to clients’ needs and delivers worldwide coverage via its 1000 employees and affiliates worldwide.
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