Deloitte Program Integrity – Healthcare Investigations Manager in San Francisco, California
Forensics Analytics Manager Program Integrity
Are you an analytical, data-driven professional? Are you interested in a role that uses leading edge analytics and offers an opportunity to provide front line support to solve our clients most challenging problems? If so, the Forensic Analytics practice within Deloitte Transactions and Business Analytics LLP (DTBA) is the place for you!
Forensic Analytics is a fast-growth practice within Deloitte Risk and Financial Advisory that centers around several of the hottest areas of business today analytics, forensic analysis, and litigation support and the specialized skills that make careers in these areas both fascinating and in high-demand. Our Analytics team makes extensive use of data, statistical and quantitative analysis, rules-based methods, and explanatory and predictive modeling to bring insights to client issues in the forensic and transaction domains. We work with specialists in many areas, and we apply our solutions to a wide range of highly interesting and complex corporate challenges, such as forensic investigations, sales fraud, anti-corruption compliance, restructuring, safety and quality, enterprise fraud and misuse management to explain what has occurred in the past and to support informed decision making for the future. Our work increasingly employs specialized competencies, such as advanced analytics, visualization, and geospatial techniques.
Work you ll do
Provide domain experience in Fraud, Waste and Abuse (FWA) Investigations
Guide the development and review of new FWA rules
Maintain a deep, working understanding of CPT, HCPCS, and ADA dental procedures codes and standard claim processing policies as defined by our clients
Managing our investigations team identifying potential fraud, waste, abuse, or improper payment.
Performing and interpreting medical, pharmacy and dental billing patterns to identify potential fraud, waste, abuse, or improper payment.
Interpreting policies to validate proper payment was made.
Serve as a Subject Matter Expert , adding interpretive value to data presented or experienced insight into a functional process or issue
Preparing and presenting complex written and verbal materials (reports, findings and presentations)
Contributing to a strong client relationship through interactions with client personnel on investigation-related issues.
Supervise, lead, and train junior staff in the aforementioned activities and career counseling
Responsible for managing solutions, delegating resources, and helping to ensure quality assurance principles are met across projects and deliverables
Assuming responsibility for small components of engagements. May have greater role on small engagements.
Maintain technical knowledge within industry and service line and leverage deep subject matter knowledge on engagements
Contribute to new business proposals and client pursuits and lead proposal development
Manage own personal and professional development; seek opportunities for professional growth and expansion of consulting skills and experience
Network and negotiate to identify and sell potential new services or expand existing engagements by leveraging client relationships
Generate marketplace eminence through the creation of intellectual property across a host of mediums including but not limited to: articles, whitepapers, webcasts and other audio visual presentations
As the regulatory landscape continues to shift and grow in complexity, companies are facing unprecedented compliance challenges and close regulatory scrutiny. We provide solutions in health care compliance, risk and technology-driven managed services. Managing your financial, operational, and reputational risk to allow you to focus on what matters most - the patient, innovation, and the greater health care marketplace.
Bachelor's degree in Accounting, Business, Finance or other Business-related field
5 years of investigations experience
2 years in a technical or functional lead role
Experience mentoring and coaching others
Extensive knowledge of medical and dental procedure codes, claims processing, and provider relations, as well as the ability to understand the cascading impact of claims processing policy changes on key performance indicators, claim costs, and overall financial health of the organization
Proven leadership skills demonstrating strong judgment, problem-solving, and decision-making abilities
Experience managing senior-level client relationships
Experience presenting to clients or other decision makers to present and sell ideas to various audiences (technical and non-technical)
Pre-sales, proposal, and RFP experience
Must be able to obtain and maintain required clearance for this role
Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future.
Experience reviewing dental claims, charts, and x-rays
Experience reviewing and interpreting dental policy
Previous experience as a dental adjudicator
Accredited Healthcare Fraud Investigator (AHFI)
Certified Professional Coder (CFE)
Certified Fraud Examiner (CFE)
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