Fraud, Waste & Abuse (FWA) Coordinator

Doctors Healthcare Plans • Coral Gables, FL

2d

About The Position

Provide operational and administrative support that enables FWA leadership, investigators and analysts focus on fraud investigations, case management and regulatory compliance. The ideal candidate is polished, highly organized, self-directed, and thrives in a demanding environment with multiple competing priorities. The candidate must possess excellent judgment, exceptional attention to detail, strong interpersonal skills, with the ability to manage highly sensitive and confidential case files.

Requirements

• Minimum 3 year's experience in healthcare and/or Medicare Advantage experience
• Knowledge of Medicare Advantage, CMS and AHCA regulatory requirements
• Research and investigative skills
• Able to multi-task and thrive in high-pressure environment
• Excellent oral and written communication
• Proficient with MS Word, Excel, PowerPoint and Adobe

Responsibilities

• Case Intake & Tracking: Work CMS-HPMS and AHC A -MPI memos, Monitor FWA inbox and referrals, Log FWA referrals and assess before an investigation is opened, Ensure case files in tracking system (Inovaare) are complete and audit-ready, Track reporting logs
• Provider & Member Correspondence: Coordinate requests for medical records and supporting documentation, Manage correspondence with providers, members, vendors, and regulatory agencies
• Reporting & Analytics Support: Support SIU and audit activities
• Documentation: Support the development of Policies & Procedures, formats and job aides
• Other: Meet performance goals as established for the position, Perform additional duties and responsibilities as assigned by management

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed