Assistant Director of Medicare Advantage Audit and Fraud Compliance

Description

As the Assistant Director of Medicare Advantage Audit and Fraud Compliance, you'll play a crucial role in safeguarding our health plan resources and upholding regulatory standards.

In this role, you'll develop and execute strategies to detect and address non-compliance, Fraud, Waste, and Abuse (FWA) within our Medicare Advantage and Prescription Drug programs. Leading a team of managers, you'll oversee internal audits, FWA detection through data mining, and ensure compliance with CMS and DMHC regulations.

Key responsibilities include:

• Oversee aspects of the Medicare Advantage Prescription Drug Anti-Fraud, Special Investigations Unit (SIU), and Audit Programs through subordinate managers.
• Develop and implement strategies to detect non-compliance and FWA using data mining and internal audits.
• Ensure compliance with regulatory requirements related to non-compliance, FWA, and SIU.
• Guide strategic goals to manage health plan resources effectively and align with broader system initiatives.
• File necessary documentation with CMS and DMHC to demonstrate compliance or identify risk areas.

Salary Range: $140,200 - $331,800/annually