Top 6 Fraud supervisor Jobs in Kentucky

Supervisor - Audit/Investigation
Qlarant —Kentucky
- $66,285 - $95,000 a year
- Full-time
- Remote
- Bachelor's degree
- Senior level
Manager, SIU Prepay Investigations
Centene —Kentucky
- $87,700 - $157,800 a year
- Full-time
- Remote
- Management
- Mid-level
- Supervising experience
- Paid holidays
- Health insurance
Manager, Fraud (Debit Card) Operations
Fidelity Investments —Covington, KY
- Full-time
- Mid-level
- Office
- Finance
Senior Manager, Fraud (Debit Card) Operations
Fidelity Investments —Covington, KY
- Full-time
- Office
- Finance
- Bachelor's degree
Forensic Accounting Manager
Dean Dorton —Fort Wright, KY
- 6 years
- Microsoft Outlook
- CPA

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Supervisor - Audit/Investigation

Qlarant -
Kentucky

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Job Details

Full-time
$66,285 - $95,000 a year

Qualifications

Project team coordination
Healthcare financial misconduct investigations
Staff supervision
Investigations regulatory compliance
Legal presentation of evidence
Medicare
Auditors team management
Audit report preparation
Project documentation
CMS
Court testimony
Forensic audits
Certified Fraud Examiner
Performance feedback (performance evaluation method)
Quality control audit
Quality reports
Audit Reporting
Team development
CMS regulatory compliance
Quality assurance audits
Bachelor's degree
Case review audits
Medicare regulations
Collaborating with law enforcement agencies
Healthcare billing investigations
Data verification
Document quality checks
Medicaid
Investigative reports
Overseeing audit functions

Full Job Description

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for underserved communities.

Best People, Best Solutions, Best Results

Job Summary:

Oversees audits/investigations and audit/investigation workload. Performs in-depth evaluation and makes field level judgments related to audits/investigations of potential Medicare fraud waste and abuse audits/investigations or cases compliance cases (e.g. Medicare and/or Medicaid) that meet established criteria for referral to the appropriate agency(ies) for administrative action or to law enforcement for criminal action.

Essential Functions:

Reviews new audits/investigations and/or incoming leads to determine appropriateness and assigns to auditors/investigators; vets providers as required with appropriate agency(ies) and law enforcement; supervises vetting process. Reviews audit/investigation plans and priorities to ensure appropriateness and quality for the specific functions/workload assigned to team.
Conducts file reviews regularly of audits/investigations to ensure audit/investigation plan is appropriate and the audit/investigation file documents are entered and summarized within the case tracking systems appropriately. Reviews auditor/investigator requests for information, data, reports, and correspondence to ensure quality and appropriateness.
Supervises and conducts audit/investigation actions such as interviewing, onsite audit/investigation, and/or site verification as needed. Leads audit/investigation projects including developing an audit/investigation strategy, conducting meetings with stakeholders, reviewing project actions for quality, and documenting findings in reports for management.
Communicates with the Data and Medical Review departments to ensure efficient audits/investigations. Prepares and presents audits/investigations, overpayments, and questions for stakeholder meetings.
Documents audit/investigation information and file reviews (interviews, events, findings, communications, etc.) into the case tracking systems and updates systems as needed. Determines audit/investigation appropriateness of fraud, waste, and abuse issues in accordance with pre-established criteria. Reviews audit/investigative findings with auditors/investigators and approves course of action. Supervises and prepares team’s audits/investigations for the Major Case Coordination meetings and reviews for quality assurance.
Initiates and maintains communications with law enforcement and appropriate regulatory agencies including presenting or assisting with presenting audit/investigation findings for their consideration to further audit/investigate, prosecute, or seek other appropriate regulatory or administrative remedies. Supervises administrative remedies in accordance with major case coordination direction (e.g. payment suspensions, revocations, provider education) and reviews for quality assurance. Reviews and approves closing summary of audit/investigation.
Collects information and documentation as requested by internal and external stakeholders (e.g. CMS, law enforcement, FOIA requests) and submits, as required.
Collaborates with other program integrity contractors, as needed.
Testifies at various legal or administrative proceedings, as necessary.
Manages team performance through regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.

Level of Supervision Received:
Drives work independently and escalates questions and issues, as needed

Education (can be substituted for experience):
Minimum Bachelor's Degree required

Work Experience (can be substituted for education):
5 - 7 years of experience required; 8 - 11 years preferred

Certification(s):
Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator Certification preferred

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.

Qlarant is a drug-free workplace. All offers of employment are contingent upon successful completion of pre-employment background and drug screens.

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Refine Your Search

fraud supervisor jobs in kentucky

Supervisor - Audit/Investigation

Manager, SIU Prepay Investigations

Manager, Fraud (Debit Card) Operations

Senior Manager, Fraud (Debit Card) Operations

Forensic Accounting Manager

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