Manager Fraud Waste and Abuse

Frequent and substantive contact with external and internal customers and management.

The Manager of Fraud, Waste & Abuse Services helps to lead a group of supervisors focused on Cotiviti's FWA Services. In this role, you will participate and actively contribute in the Revenue Products/Solutions through prioritization of innovation based on development of sound business cases and thorough understanding of market/customer needs and estimated market opportunity, including identification of key product gaps and strategies to reduce them (e.g., investment, partnerships, channels, etc.).

Participate and actively contribute in the Revenue Products/Solutions through prioritization of innovation based on the development of sound business cases and through understanding of market/customer needs and estimated market opportunity, including identification of key product gaps and strategies to reduce them (e.g., investment, partnerships, channels, etc.).
• Manages the medical review function for the department and ensures compliance with customer contracts.
• Supervise the work of medical reviewers and/or support staff.
• Serves as the main liaison to customers.
• Creates and conducts investigation-related training.
• Work with existing customers and prospects to understand experiences to-date and future requirements in a systematic way to develop strategic product responses, rather than "one off" client fixes.
• Identify opportunities to better integrate these revenue analytics solutions (and where relevant, other VH product solutions) to provide an improved customer experience.

Foster Teamwork and Collaboration:

• Promotes teamwork within and across groups.
• Works collaboratively with others to maintain productive working relationships within and across boundaries.
• Partners with product leadership to align clinical informatics roadmap with product releases.

Communicate with Impact:

• Speaks clearly and expresses self well in groups and in one-to-one conversations.
• Conveys written information clearly and effectively in both formal and informal documents.
• Presents a compelling case for own/team's ideas and proposals.

Executive Presence:

• Interacts with senior executives at clients/prospects as peer.
• Is seen as a collaborative though partner able to understand business challenges and craft solutions to meet those challenges.
• Hire, develop, coach, lead and retain top-tier talent, with a focus on building and improving a team and culture that can assist in employing best in class practices to support and drive high levels of internal and external customer satisfaction.
• Complete all responsibilities as outlined on annual Performance Plan.
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

• Advanced degree in applicable field.
• Bachelor's Degree (preferred) in related discipline, or the equivalent combination of education, professional training and work experience.
• Certified Professional Coder (CPC) Required.
• 4 + years of experience in health care fraud investigations or the management of an SIU. Experience in coding/medical auditing and health care analytics (population health/business intelligence preferred) including experience in software product management with a preference for healthcare product management experience preferred (experience as a user of health care data analytics technologies is also relevant)
• Exposure to/experience across payer, provider, government, and employer (direct & channel), perspectives a strong plus.
• Knowledge of critical health care data sets and coding systems (e.g., claims, clinical, lab), etc.
• 2 + years Management experience leading teams
• The ability to credibly interface with internal and external senior executives, including the ability to communicate with non-management stakeholders effectively
• Ability and presence to work with senior executives (internal, clients, prospects) in a consultative manner to solve their business problems through our current tools and future development initiatives
• A track record and innate desire to build outstanding, motivated and productive teams by identifying and hiring A-players, investing in coaching and feedback, communicating transparently, and providing high energy leadership
• Strong problem-solving skills with ability to guide development of analytical models to support business decisions

Job Demands:

• Willing to travel up to 15% of the time
• After hours and/or weekend work may be required where necessary for major deliverables /deadlines.
• Must be able to sit and use a computer keyboard for extended periods of time.
• Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.

Mental Requirements:

• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.
• Must have the ability to positively handle/manage stress, such as high work volume and frequent change.

Physical Requirements and Working Conditions:

• This is a work-at-home position (US only).
• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide a dedicated, secure work area.
• Access to high-speed internet is required (all other equipment will be provided).
• No adverse environmental conditions are expected.

Base compensation ranges from $105,000 to $130,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

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