Program Integrity Manager in Atlanta, GA at Beacon Health Options

Date Posted: 8/17/2018

Job Snapshot

Job Description

About The Position:

The Program Integrity Manager Implements the Program Integrity/Fraud, Waste, and Abuse Plan and all related activities at the Atlanta Engagement Center under the direction of the AVP, Corporate SIU and Engagement Center Vice-President/CEO. Chairs the Georgia Compliance Committee and is responsible for all of the Committee’s functions and activities. Operates as the primary resource and contact for all fraud, waste and abuse investigation and prevention, provider monitoring and audit related activities with DBHDD, OIG and the Attorney General’s Office – MFCU. Operates as the primary resource for all privacy investigation and prevention under the AVP, Corporate Compliance.

Position Responsibilities:

  • Responsible for the performance of program integrity provider audit procedures and assisting in the implementation of the Corporate Fraud, Waste, and Abuse Plan and related activities under the direction of the AVP, Corporate SIU.
  • Operates as a primary resource for Beacon Health Options Georgia and contact for fraud, waste and abuse investigation and prevention, provider monitoring and provider audit related activities. Operates as a primary resource for compliance and privacy activities within the Atlanta Engagement Center.
  • Manages the day-to-day activities of Georgia’s program integrity/fraud, waste, and abuse; privacy; and compliance activities and ensures quality of annual provider audit plans; case development, documentation and dispositions; communication with providers, overpayment recoveries, law enforcement referrals, training of staff, coordination with other departments, etc.  Escalate cases to the AVP, Corporate SIU as appropriate.
  • Establishes, monitors, analyzes and regularly reports metrics for program integrity/fraud, waste, and abuse; privacy; and compliance activities. Report on program integrity provider audits and performance to appropriate management committees.
  • Maintain Privacy Web based application in an accurate and timely manner. Create and analyze trended privacy violation reports for engagement center management, for the purpose of identifying opportunities for improvement, assessing the effectiveness of such improvements, and sharing of best practices.

Position Requirements:

  • Education: Bachelor’s degree in accounting, finance, management, healthcare, law enforcement or equivalent field.  Master’s degree preferred.
  • Licenses: :  If degree is in healthcare, then current state licensure as results from the degree program, e.g., RN, LPN, Physician Assistant, or CRNP, etc. : Preference will be given to candidates with certifications related to their professional training, to include:  Association of Certified Fraud Examiners (CFE); Accredited Healthcare Fraud Investigator (AHFI); Certified Internal Auditor (CIA); or Professional Coding through AAPC (CPC) (CPC-H) CPC-P) or AHIMA (CCS) (CCS-P).
  • Relevant Work Experience: Minimum of five (5) years’ experience in healthcare, accounting (public or private), or healthcare coding, with at least three (3) of the years in fraud and abuse and/or white collar crime investigations are required. Three (3) years of supervisory experience and three (3) years’ experience managing an audit program are preferred.  Preference will also be given to candidates with experience in a managed care environment. A combination of education and experience exceeding the minimum requirements will also be considered.

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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled

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