Fraud Management Officer
The primary responsibility of the Fraud Management Officer is to investigate, identify and, resolve any incidents that may occur between caregivers and Participants within the organization. The Critical Incident Coordinator will be responsible for investigating, gathering information, concluding, and attempting to prevent recurrence related to Participant and caregivers. The Fraud Management Officer is to initiate investigation upon being informed. Investigation may include, but not limited to the following: documenting, devising solutions and offering support in necessary situations. The purpose of this role is to assume responsibility of Fraud Management Officer while following company’s, local, and state guidelines.
A. Ensure reportable incidents related to Participant’s health/safety are reported in compliance to local, Community Health Choices (CHC) and federal guidelines.
B. Monitoring of reportable/non-reportable incidents.
C. Oversight and collaboration with staff members/management regarding corrective measurement and incident responses.
D. Review of all reported incidents submitted by Patient Care Coordinator (PCC).
E. Triage reports of incidents; make sure protective measures are in place for participant’s health/safety.
F. Discuss and implement preventable measures are in place to avoid the reoccurrence of the incident.
G. Coordinate with appropriate parties of the status reportable/non-reportable incidents.
H. Review incidents to ensure all follow-up are done in a timely manner as per guidelines.
I. Ensure that investigations and conclusions are thoroughly completed within timeframes adhered by CHC.
J. Review data for trends and ensure preventable measures are in place to address reportable/non reportable incidents.
K. Compiling incident statistics monthly to compile annual quality reports.
L. Requesting additional information from external sources to thoroughly examine incidents.
- Minimum of an Associate’s Degree required, Bachelor’s Degree preferred or combination of experience
- Strong knowledge of critical thinking and Home and Community Services Information System (HCSIS) Symptoms.
- 2+ years’ experience in a Case Management or Administrative support role to leadership staff
- Demonstrated capability maintaining strict confidentiality with employee information
- Knowledge of principles and practices of basic office management and organization
- Strong typing and computer application skills
- Computer proficiency and working knowledge of Microsoft programs required
- Strong interpersonal and business partnering skills
- Good judgement and decision-making skills
- Must be well organized, accurate and attentive to detail
- Excellent communication, public relations and follow up skills
- Must be able to work independently and have strong written and verbal communication skills
- Must effectively enforce company policies without alienating the Participant/caregiver
- Customer Service
- Belief in the Home Care concept.
Job Type: Full-time
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