Responsible for the intake, review and documentation of Fraud, Waste and Abuse (FWA) allegations referred to the Special Investigations Unit (SIU). Provides recommendations to close inquires or open investigative cases to pursue the prevention, detection, and prosecution of healthcare FWA. Assists in the recovery of funds lost due to FWA and reports cases of suspected fraud to the Office of Program Integrity. Manages regulatory notices (HPMS memos), case summaries and coordinates with external entities, including but not limited to federal, state and law enforcement. Works both independently and collaboratively with the SIU, and other Business Areas to ensure the proper oversight of Neighborhood’s FWA program and assists in identifying areas of non-compliance within the organization. Assists in the preparation of internal and external FWA reporting.
Core Company-Wide Competencies:
Job Specific Competencies:
Flexible Work Arrangement:
Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.
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Neighborhood is an EOE M/F/D/V and an E-Verify Employer