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Job Seekers, Welcome to NQF Quality CareersActive Advanced Search Filters: (Click to remove)Search FiltersUse this area to filter your search results. Each filter option allows for multiple selections.NEW! NEW!Massachusetts Department of Public Health, Bureau of Infectious Disease and Laboratory SciencesJamaica Plain, Massachusetts
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NEW! NEW!Loading... Please wait.Manager Special Investigation Unit - Community Health ChoiceJOB SUMMARY: The Manager, SIU manages a team to detect, investigate, remediate and refer to state regulatory agencies and/or law enforcement as appropriate, incidents of fraud, waste and abuse (FWA) arising in connection with medical, behavioral, dental, transportation, pharmacy, and other healthcare services. This position determines correct coding, review claims, review medical records, and billing data from all types of healthcare providers for aberrant billing patterns and is responsible for managing case assignments, case development, case review, overpayment recoveries, managing RFIs, state agency and/or law enforcement referrals, training of staff, and coordination with other departments to mitigate and remedy FWA. The Manager, SIU develops, implements and manages strategi
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