administer fraud, waste, and abuse (FWA) duties for CareOregon
perform fraud investigations
provide regular FWA reporting
develop and operate an effective FWA program in accordance with CMS requirements
perform routine FWA investigations, audits, and corrective actions
prepare reports of audit findings
respond to routine and ad hoc requests from external regulatory agencies
prepare routine and ad hoc reports for internal and external leaders
assist in developing and maintaining documentation system for FWA regulatory requirements
review and recommend policy and procedure revisions
attend internal and external FWA and compliance-related meetings
assist in providing effective FWA training and education to staff
educate providers on appropriate documentation and coding

Minimum 2 years’ experience in FWA, compliance and/or audit in a highly regulated industry
Oregon Medicaid experience or health plan experience preferred
CPC (Certified Professional Coder) or RHIT (Registered Health Information Technician) or CFE (Certified Fraud Examiner)
Understanding of healthcare fraud, waste, and abuse
Knowledge of State and Federal compliance and FWA requirements for Medicare and Medicaid
Knowledge of investigative techniques including interviews, data analytics, evidence gathering, case documentation
Strong research, investigative and problem-solving skills

medical, dental, vision, life, AD&D, and disability insurance
health savings account
flexible spending account(s)
lifestyle spending account
employee assistance program
wellness program
discounts
multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.)
strong retirement plan with employer contributions
PTO and Paid State Sick Time
paid holidays, volunteer time, jury duty, bereavement leave, and more

Special Investigations Unit Investigator

Key skills