Program Director overseeing contract requirements and operations for Medicare and Medicaid in the Midwestern Region. Ensuring compliance, quality assurance, and stakeholder communication for federal health agency.
Responsibilities
Oversight of contract requirements and jurisdictional operations
Lead, manage, and support a team
Ensure appropriate staffing and resource allocation
Maintain effective communication with internal staff and external stakeholders
Ensure compliance with contract requirements including quality, cost control, and timeliness
Implement and maintain a quality assurance program
Submit timely and accurate monthly cost reports and corrective action plans as needed
Ensure timely and quality submission of deliverables and ad hoc requests
Maintain superior business relations with CMS, Law Enforcement, MACs, and other partners
Requirements
Bachelor's degree with 20 years of professional experience OR Master’s degree with 15 years of professional experience
At least eight years in healthcare, Medicare, Medicaid, or related private insurance field
Minimum of seven years in a progressive management capacity with responsibility for managing complex systems and workflows
US Citizenship is required
Must be able to obtain Public Trust clearance
Intensive experience conducting and overseeing healthcare fraud investigations for healthcare payers and/or law enforcement
Customer familiarity with the CMS Center for Program Integrity (CPI)
Expertise in the Medicare program and the CMS/CPI’s fraud, waste, and abuse workflow
Credentials such as: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AFHI), or similar
Proficiency in MS Office Applications (Word, PowerPoint, Outlook, Excel, Project) and MS SharePoint.
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