Conducts routine and impartial audits and investigations into fraud, waste, and abuse allegations to ensure program integrity. Compiles detailed records, interviews stakeholders, and provides professional recommendations for resolution and closure.
Conducts routine and impartial audits and investigations into fraud, waste, and abuse allegations to ensure regulatory compliance. Compiles detailed findings, interviews stakeholders, and provides accurate recommendations to management for resolution.
Conducts impartial audits and investigations into fraud, waste, and abuse allegations to ensure regulatory compliance. Compiles detailed findings, interviews stakeholders, and provides professional recommendations for case resolution.
The supervisor oversees audit and investigation workloads, ensuring in-depth evaluations of potential fraud, waste, and abuse in government programs. They manage team performance, conduct file reviews, and maintain communications with law enforcement and regulatory agencies to ensure program integrity.
The Senior Director serves as a strategic advisor to the Corporate Security Officer, overseeing enterprise-wide information security programs and risk reduction initiatives. They are responsible for developing security policies, managing vendor risk, and coordinating compliance audits across the organization.
The Director of Projects plans, directs, and leads large-scale projects to ensure they meet strategic objectives, budget, and quality standards. They also manage stakeholder relationships, oversee contractual compliance, and provide strategic recommendations to senior management.
The Deliverables Coordinator II supports project teams by maintaining documentation, tracking progress against deadlines, and identifying potential risks. They facilitate communication between stakeholders and ensure project deliverables meet established quality standards.
Performs medical record and claims reviews to identify potential fraud, waste, and abuse within Medicare and Medicaid programs. Supports investigative processes by completing case summaries, conducting field audits, and providing data reporting.
Lead complex projects from planning through delivery, managing scope, schedules, budgets, risks, resources, and cross-functional teams while reporting progress to senior leaders and stakeholders. Coordinate CMS Division of Investigative Support communications, legal-document notifications, file reviews, and the payment suspension workload through resolution.
Supports the legal team by managing regulatory inquiries, FOIA requests, and administrative hearing documentation. Assists in document collection for litigation holds and provides general administrative support for case files.
Surveyors are responsible for conducting in-person, telephonic, and virtual NCI surveys with individuals receiving HCBS services. They must document responses accurately, maintain participant privacy, and report findings to the project team.
Conducts impartial audits and investigations into customer claims to ensure validity and compliance with regulatory standards. Compiles detailed findings, prepares comprehensive reports, and communicates results to stakeholders to facilitate claim resolution.
The Quality Review Specialist facilitates evaluations to assess the quality and safety of services provided to individuals with intellectual and developmental disabilities. They also provide technical assistance, generate reports, and collaborate with stakeholders to ensure compliance with regulations and continuous service improvement.
