Analyst, Compliance, Fraud, Waste & Abuse

Compliance Fraud, Waste & Abuse Analyst

If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn't just welcomed it's nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don't just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it's a calling that drives us forward every day.

Job Overview

The Compliance Fraud, Waste & Abuse Analyst is responsible for supporting the prevention, detection, investigation, reporting, and related to health care fraud, waste, and abuse. This role is responsible for reviewing and analyzing information to draw conclusions on allegations of FWA and recommend appropriate action. Conducts both preliminary assessments of FWA allegations determining whether the investigation and / or audit identified potential fraud, waste, or abuse, and end-to-end full investigations, findings identification and communications development, and recommendations and preparation of overpayment identifications and closure of investigative cases. Activities include : identifying areas of investigation, collecting, analyzing, and interpreting data, spotting trends, and writing reports and recommendations for internal and / or external stakeholders. The position works collaboratively with the program lead and internal departments, including the Office of General Counsel, Medical Director(s), and subsidiary organizations to achieve and maintain appropriate enterprise anti-fraud program effectiveness.

Minimum Requirements

• An Associate's or Bachelor's degree is preferred
• A minimum of 1 year of experience as an FWA analyst / investigator is required.
• Experiences conducting data mining in the healthcare insurance industry and claims-related experience.
• Knowledge of coding, reimbursement, and claims processing policies
• Knowledge of the law and regulations as it relates to fraud and fraud investigations.

Compensation

$68,640.00 - $85,800.00 annually

Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate's value and the role's strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives.

Benefits & Career Development

AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.