Martin's Point Health Care

We are people caring for people.

Special Investigations Unit Director

DirectorDirectorFull TimeRemoteTeam 501-1,000H1B No SponsorCompany SiteLinkedIn

Location

Maine

Posted

12 days ago

Salary

Not specified

Bachelor Degree10 yrs expEnglish

Job Description

• Lead Martin’s Point’s Audit & Recovery team • Develop and implement a fraud, waste, and abuse program • Ensure all audits and investigations are performed and documented • Establish and maintain direct relationships with key stakeholders • Monitor and evaluate vendors performing audit and recovery activities • Respond to all legal inquiries including subpoenas and court appearances • Prepare reporting for business teams, Executive Management Team, and the Board of Directors • Coordinate participation in industry associations, coalitions, and stakeholder groups

Job Requirements

  • Bachelor's degree in Accounting, Criminal Justice, Finance, Medical Professional, Economics, Operations Management, or related field or equivalent
  • Juris Doctor or other applicable advanced degree preferred
  • 10+ years of related compliance, FWA, and/or special investigation experience in managed care or CMS
  • Risk Adjustment experience/expertise preferred
  • Track record of progressive leadership responsibilities and achievements
  • Significant experience partnering with cross-functional teams
  • Required License(s) and/or Certification(s): CFE, PCI, or CCJS certification preferred

Benefits

  • Organizational culture of trust and respect
  • Professional development opportunities
  • Equal opportunity employer
  • Reasonable accommodations for applicants and employees with disabilities

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