Qualifications for a Job in anti-medicare medicaid fraud

Post Date 11/12/2008

Employer WellPoint, Inc

Benefits
Job Description

TrustSolutions is a wholly owned subsidiary of Government Health Services, LLC, and is part of the WellPoint family of companies. TrustSolutions holds a Medicare Program Safeguard contract with the Centers for Medicare & Medicaid Services to help reduce fraud and abuse in the Medicare Program. Headquartered in Milwaukee, Wisconsin, TrustSolutions also has offices in California, Illinois, Michigan, Virginia, Indiana, Florida and Texas.

Bring your expertise to our innovative, performance-focused culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.

Healthcare Fraud Program Director
This position is contingent upon contract award, and can be filled in any of these locations: PA, NY, MD, DC, DE, ME, MA, NJ, CT, RI, NH, VT

Responsible for the development and ongoing management of Medicare and Medicaid Program Integrity anti-fraud programs that are multi-state, multi-function and multi-year in scope. Provides leadership to program managers, project managers and sub-contractors. Typically reports to an executive or senior manager. Program directors typically manage programs, their associated budgets and compliance with contractual requirements that require managing activities and resources of multiple departments or business areas of the organization. Program directors typically support business strategies through an integrated portfolio of programs, projects and initiatives. Essential duties include, but are not limited to: coordinates and manages the development, approval, implementation and compliance of on-going programs; establishes program governance when needed to assure response to issue escalation; develops program budget; ensures program meets its stated objectives; provides subject matter expertise in response to day to day business issues; researches applicable subject matter practices and remains aware of industry trends; manages relationships and partners with corporate and regional business areas; coordinates training related to program; develops program success measures and performs periodic assessments of program success; and performs other duties as assigned.

Qualifications

BA/BS degree and 14 years of experience in related field or an equivalent combination of education and experience or 10 years related experience and a MA degree required with at least 3 years as a manager responsible for managing complex systems and work flows or large contracts for private insurance companies, federal agencies or state agencies related to the detection and prevention of healthcare fraud.
Understanding of complex business processes related to federal contracting required.
Project management experience preferred.
2+ years experience with Medi Medi data
2+ years experience with Medicare Program Integrity Work
2+ years experience with Medicare, Medicaid, or Medi-Medi data analysis
3+ years experience with Medicare claims, including types A, B, C, D, DMEOS, and Regional Home Health
Demonstrated leadership skills and proven planning and organization skills to ensure development and maintenance of relationships across organization is required.