NCI: As the Program Integrity (PI) Manager ( Operations Director I ) supporting AdvanceMed, you will be responsible for management and oversight of program integrity activities for the Investigations MEDIC and for coordination of activities between internal teams. In assuming this position, you will be a critical contributor to meeting NCI AdvanceMed's mission: To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse.
NCI is always seeking talent and although this position is contingent upon an open position, we encourage you to apply.
Highlights of Responsibilities:
- Provide direction to program integrity staff regarding the identification, development, and resolution of Medicare fraud complaints, investigations, and cases.
- Ensure that work products and processes are in compliance with Statement of Work, Program Integrity Manual, and other contractual requirements.
- Build relationships and foster communications with CMS and other Medicare contractors and stakeholders.
- Prepare and deliver reports/deliverables and technical documents to Centers for Medicare & Medicaid Services (CMS) and other Medicare stakeholders in accordance with contractual requirements.
- Coordinate with other business units within the contract organization (e.g., Medical Review, Data Analysis) related to the identification and development of Medicare fraud complaint, investigations, and cases.
- A minimum of 10 years experience in conducting health care fraud investigations; the last 3 of the 10 years must be in a supervisory capacity in the general area of program integrity investigations.
- Medicare Parts C and D knowledge is required.
- A strong background in a range of program integrity activities is required.
- Bachelors degree in criminal justice, health science administration or other related areas of study that pertain to healthcare program integrity. Ten or more years of related PI experience may be substituted in lieu of the bachelors degree.
Preferred Education and Experience:
- Law enforcement experience is preferred.