Fraud, Waste and Abuse (FWA) Compliance Training Specialist

Briljent LLC

Job Description

less thanp>less thanstrong>Summary:less than/strong>The FWA Training Specialist will act as a subject matter expert on Medicaid and Medicare Fraud, Waste and Abuse (FWA). The Specialist will bring their audit and compliance knowledge to external providers and team members to educate and increase awareness. The Specialist will provide their expertise for a large healthcare client.less than/p>less thanp>Must be eligible to work in the U.S. No sponsorships are available at this time.less than/p>less thanp>less thanstrong>less than/strong>less thanstrong>Essential Duties:less than/strong>less than/p>less thanul>less thanli>Apply knowledge of current FWA Schemes, coding guidelines and medical policies to identify areas of risk for Fraud, Waste or Abuseless than/li>less thanli>Stay current on published fraud casesless than/li>less thanli>Develop and deliver external FWA awareness training programs and workshopsless than/li>less thanli>Develop and deliver provider education programs focusing on FWA best practicesless than/li>less thanli>Participate in the ongoing monitoring of member and/or provider Fraud, Waste and Abuse through random audits, data analysis, and medical record reviewless than/li>less thanli>Participate in the tracking, review and reporting of FWA referrals and outcomes including the creation of reports for tracking and trending suspected FWAless than/li>less thanli>Apply expert knowledge of compliance to support ongoing effortsless than/li>less than/ul>less thanp>less thanstrong>less than/strong>less than/p>less thanp>less thanstrong>Required Skills:less than/strong>less than/p>less thanul>less thanli>Expert knowledge of compliance standards and practice with regards toless thanstrong>healthcare Fraud, Waste and Abuse (FWA)less than/strong>.

less than/li>less thanli>Ability to use system tools to conduct data analysis on Medicare, Medicaid and health insurance billingless than/li>less thanli>Working knowledge of medical codingless than/li>less thanli>Conduct systematic and in-depth research analysis on billing dataless than/li>less thanli>Working knowledge of reviewing a diverse set of statistical dataless than/li>less thanli>Working knowledge of reviewing financial dataless than/li>less thanli>Excellent ability to write clean and concise reports on investigative findingsless than/li>less thanli>Extremely detail-orientedless than/li>less thanli>Superior organization skillsless than/li>less than/ul>less thanp>less thanstrong>less than/strong>less than/p>less thanp>less thanstrong>Education and Experience:less than/strong>less than/p>less thanp>less thanstrong>less than/strong>less than/p>less thanp>less thanstrong>Must have working experience or education in healthcare fraud, waste and abuse.less than/strong>less than/p>less thanul>less thanli>Requires a BA/BS degreeless than/li>less thanli>3-5 years' experience in healthcare, healthcare compliance, or related area, or any combination of education and experienceless than/li>less thanli>1-2 years of Internal or external audit experience or 1 -2 years Regulatory or Compliance experienceless than/li>less thanli>Medical Coding experience preferredless than/li>less thanli>Professional certification of CFE, AHFI preferredless than/li>less thanli>Knowledge in business operations a plusless than/li>less than/ul>less thanp>less than/p>less thanp>less thanstrong>Physical Requirements and Environmental Conditionsless than/strong>:less than/p>less thanp>The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.less than/p>less thanp>While performing the duties of this position, the employee is regularly required to sit and use hands to handle, or feel objects, a keyboard and other office equipment. The employee frequently is required to sit in meetings for long periods o

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