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