Remote Fraud Investigator Jobs in Baton Rouge, LA

This position is available for remote/WFH within Louisiana, candidates must reside in Louisiana.

Serves as the compliance and privacy manager for assigned areas of the company or an SBU as applicable. Assists with regulatory and contract compliance for business managed by the Care Center or supported by corporate compliance. Responsible for the implementation of or support of the SBU and/or Corporate Compliance Program, Health Insurance Portability and Accountability Act (HIPAA) compliance, including audits and the preparation for state and customer audits.

• If applicable, oversees the implementation and ongoing operation of the Compliance Program for the assigned SBU(s).
• If applicable, develops and annually updates a formal written compliance program for the assigned Care Management Center and educates staff about compliance and the appropriate details of the compliance program.
• Directs federal and state regulatory and compliance activities.
• Customizes corporate policies where necessary to address state regulatory standards and/or contractual requirements and, where applicable and works with corporate compliance on any customizations that are required due to state regulatory standards.
• Serves as a liaison for customers on legal and regulatory issues.
• If applicable, chairs the local compliance committee meetings.
• Coordinates activities with the Internal Audit and Special Investigations Unit (SIU) on compliance matters including fraud, waste, and abuse auditing and monitoring, as directed.
• Ensures corrective actions are implemented for all known compliance deficiencies. Submits reports to the Quality Improvement Committee (QIC), Compliance Committee, Business Unit Manager, and the corporate Compliance Department as appropriate.
• Maintains expertise related to authorization and non-authorization correspondence requirements from the perspective of the Employee Retirement Income Security Act of 1974 (ERISA), National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), federal regulations and state law.
• Assists in review of standard correspondence, notifying policy content experts of changes to standard policies, and working with IT regarding system changes as it relates to correspondence.
• If applicable, attends customer meetings to report on compliance matters.
• Serves as central contact for internal and external customers regarding certain parts of the corporate compliance program as assigned or, where applicable, security, HIPAA, and anti-fraud efforts within the assigned Care Center.
• Assists with internal and external audits and reporting, including periodic reports documenting compliance status..
• If applicable, oversees Care Center-delegated entities and their compliance activities and assure that compliance data from the delegated entities are reported to the Quality Improvement Committee (QIC).

The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

Other Job Requirements

Responsibilities

Knowledge of HIPAA, federal and state regulatory processes.
Medicare Advantage and/or Medicaid managed care experience preferred but not required.
Strong interpersonal, organizational, and project management skills.
Ability to research, obtain, coordinate, and integrate feedback and directions from diverse operational groups and organizations into a written product.
Excellent verbal and written communication skills.
5-8 years compliance related experience.
Experience and thorough understanding of Microsoft Office, flow charting and other relevant software systems and applications.

General Job Information

Title

Compliance Manager - Louisiana

Grade

27

Work Experience - Required

Compliance

Work Experience - Preferred

Healthcare

Education - Required

A Combination of Education and Work Experience May Be Considered., Bachelor's

Education - Preferred

License and Certifications - Required

License and Certifications - Preferred

Salary Range

Salary Minimum:

$77,785

Salary Maximum:

$124,455

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.