Responsibilities The Manager of Fraud, Waste, Abuse (FWA is responsible for leading Prominence's FWA, Subrogation, Third-Party Liability (TPL), and Payment Integrity programs. This role provides strategic direction, oversight, and leadership to ensure the effective identification, investigation, recovery, and resolution of FWA, TPL, and payment integrity opportunities. Key areas of focus include, but are not limited to, End-Stage Renal Disease (ESRD) coordination of benefits, Medicare Secondary Payer (MSP) initiatives, overpayment recoveries, and other cost-containment and revenue-recovery activities.
The Manager will work collaboratively across departments and external partners, this position ensures compliance with internal policies and all applicable state and federal regulations while maintaining a strong focus on accuracy, quality, financial stewardship, and timely service delivery.
Benefit Highlights:- Loan Forgiveness Program
- Challenging and rewarding work environment
- Competitive Compensation & Generous Paid Time Off
- Excellent Medical, Dental, Vision and Prescription Drug Plans
- 401(K) with company match and discounted stock plan
- SoFi Student Loan Refinancing Program
- Career development opportunities within UHS and its 300+ Subsidiaries! • More information is available on our Benefits Guest Website: benefits.uhsguest.com
Qualifications Qualifications and Requirements:- Bachelor's Degree or equivalent years of relevant work experience in Health-Related Field or Insurance required
- 3-5 years' experience in healthcare such as insurance, medical claims, medical front/back office, contracting, finance or Provider Relations
- Experience in healthcare fraud investigations, auditing, data analytics or related field
- Ability to apply knowledge of medical terminology to review claims system for approval or denial of coverage for claims related to accident/illness.
- The following certifications are preferred: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), and Certified Professional Coder (CPC)
- Ability to manage demanding investigative case load
- Strong written skills with ability to compose detailed investigative reports and professional internal and external correspondences
- Strong interpersonal skills, high level of professionalism, integrity and ethics in performance of all duties
- Excellent problem solving and decision-making skills with attention to details
- Experience in working with QNXT or any claim's processing application is preferred.
- Proficient Computer Skills: Microsoft Office (Word, Excel, PowerPoint, Outlook), Smartsheet
- Strict adherence of rules and regulations for confidentiality and compliance.
- Excellent time management skills with proven ability to meet deadlines.
- Previous experience in subrogation operations preferred.
