45 applicants
Avēsis · 2 days ago
FWA Program Integrity Investigator Business Analyst
United States
Full-time
Remote
Mid, Senior Level
$56K/yr - $87K/yr
5+ years exp
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Responsibilities
Assist in specific investigative tasks related to fraud, waste and abuse of both vision and dental investigations
Develop and deploy effective workflow processes in relation to program integrity state and federal requirements
Assist in maintaining an accurate and organized case tracking system for all dental and vision provider fraud, waste, and abuse investigations
Communicating effectively with providers in relation to open investigations or other fraud, waste, and abuse issues
Assist in the creation of new policies, procedures, letter templates, and forms as needed by the program integrity department
Accurately track overpayment recoveries, document and work with the collection agency to collect when necessary
Collect, collate, analyze, and interpret data relating to fraud, waste, and abuse referrals
Ensure compliance with applicable federal/state regulations or contractual obligations
Completing, tracking, and organizing all program integrity reporting requirements for all current and future contracts/plans
Comply with goals, policies, procedures, and strategic plans as delegated by leadership
Collaborate with state/federal partners, at the discretion of leadership, to include attendance at workgroups or regulatory meetings
Other business analyst functions/duties as needed
Qualification
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Required
Bachelor's Degree OR 5+ years of experience in healthcare program integrity or fraud, waste, and abuse investigations.
Intermediate level of proficiency in Microsoft Excel and Word
1+ years of experience in state and federal regulatory FWA requirements
1+ years of experience with local, state/federal laws and regulations pertaining to program integrity and/or healthcare fraud, waste and abuse (FWA)
1+ years of experience with Compliance Program policies, procedures and documentation standards
Preferred
Vision and/or dental office experience, i.e. coding/billing/office staff preferred but not required
Knowledge of dental and vision CPT, ICD-10 and HCPCS codes preferred but not required
Benefits
Medical, dental, supplemental health, life, and vision coverage with no wait period
Life and disability insurance
401(k) with company match
Tuition assistance
Paid parental leave and backup family care
Flexible time off, dress code, and work location policies
Employee Resource Groups promoting inclusion and diversity
Social responsibility initiatives
Company
Avēsis
Guiding you to wellness with innovative tools, equitable access, and a personal touch.
501-1,000 employees
Funding
Current Stage
Late StageLeadership Team
Sean Slovenski
Chief Executive Officer
Karim Bennis
Executive Vice President, Chief Operating Officer
Recent News
2024-01-03
2023-09-26
Company data provided by crunchbase
