United States onlyOverview
Frequent and substantive contact with external and internal customers and management.
The Manager of Fraud, Waste & Abuse Services helps to lead a group of supervisors focused on Cotiviti's FWA Services. In this role, you will participate and actively contribute in the Revenue Products/Solutions through prioritization of innovation based on development of sound business cases and thorough understanding of market/customer needs and estimated market opportunity, including identification of key product gaps and strategies to reduce them (e.g., investment, partnerships, channels, etc.).
Responsibilities
- Participate and actively contribute in the Revenue Products/Solutions through prioritization of innovation based on the development of sound business cases and through understanding of market/customer needs and estimated market opportunity, including identification of key product gaps and strategies to reduce them (e.g., investment, partnerships, channels, etc.).
- Manages the medical review function for the department and ensures compliance with customer contracts.
- Supervise the work of medical reviewers and/or support staff.
- Serves as the main liaison to customers.
- Creates and conducts investigation-related training.
- Work with existing customers and prospects to understand experiences to-date and future requirements in a systematic way to develop strategic product responses, rather than “one off” client fixes.
- Identify opportunities to better integrate these revenue analytics solutions (and where relevant, other VH product solutions) to provide an improved customer experience.
Foster Teamwork and Collaboration:
- Promotes teamwork within and across groups.
- Works collaboratively with others to maintain productive working relationships within and across boundaries.
- Partners with product leadership to align clinical informatics roadmap with product releases.
Communicate with Impact:
- Speaks clearly and expresses self well in groups and in one-to-one conversations.
- Conveys written information clearly and effectively in both formal and informal documents.
- Presents a compelling case for own/team’s ideas and proposals.
Executive Presence:
- Interacts with senior executives at clients/prospects as peer.
- Is seen as a collaborative though partner able to understand business challenges and craft solutions to meet those challenges.
- Hire, develop, coach, lead and retain top-tier talent, with a focus on building and improving a team and culture that can assist in employing best in class practices to support and drive high levels of internal and external customer satisfaction.
- Complete all responsibilities as outlined on annual Performance Plan.
- Complete all special projects and other duties as assigned.
- Must be able to perform duties with or without reasonable accommodation.
Qualifications
- Advanced degree in applicable field.
- Bachelor’s Degree (preferred) in related discipline, or the equivalent combination of education, professional training and work experience.
- Certified Professional Coder (CPC) Required.
- 4 + years of experience in health care fraud investigations or the management of an SIU. Experience in coding/medical auditing and health care analytics (population health/business intelligence preferred) including experience in software product management with a preference for healthcare product management experience preferred (experience as a user of health care data analytics technologies is also relevant).
- Exposure to/experience across payer, provider, government, and employer (direct & channel), perspectives a strong plus.
- Knowledge of critical health care data sets and coding systems (e.g., claims, clinical, lab), etc.
- 2 + years Management experience leading teams.
- The ability to credibly interface with internal and external senior executives, including the ability to communicate with non-management stakeholders effectively.
- Ability and presence to work with senior executives (internal, clients, prospects) in a consultative manner to solve their business problems through our current tools and future development initiatives.
- A track record and innate desire to build outstanding, motivated and productive teams by identifying and hiring A-players, investing in coaching and feedback, communicating transparently, and providing high energy leadership.
- Strong problem-solving skills with ability to guide development of analytical models to support business decisions.
Job Demands:
- Willing to travel up to 15% of the time.
- After hours and/or weekend work may be required where necessary for major deliverables /deadlines.
- Must be able to sit and use a computer keyboard for extended periods of time.
- Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.
Mental Requirements:
- Communicating with others to exchange information.
- Assessing the accuracy, neatness, and thoroughness of the work assigned.
- Must have the ability to positively handle/manage stress, such as high work volume and frequent change.
Physical Requirements and Working Conditions:
- This is a work-at-home position (US only).
- Remaining in a stationary position, often standing or sitting for prolonged periods.
- Repeating motions that may include the wrists, hands, and/or fingers.
- Must be able to provide a dedicated, secure work area.
- Access to high-speed internet is required (all other equipment will be provided).
- No adverse environmental conditions are expected.
Base compensation ranges from $105,000 to $130,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.
Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.
Date of posting: 05/22/2025
Applications are assessed on a rolling basis. We anticipate that the application window will close on 07/22/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.
