- Entry level
- No Education
- Salary to negotiate
If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)
The FADS Liaison & Program Integrity Consultant is responsible for identifying Medi-Cal fraud and abuse cases, HIPAA reporting requirements and specialized report development. Your understanding of Medicaid and Managed Care, private sector health industry standards, and specialized areas such as pharmacy, dental, medical, and FQHC / RHC will help you be successful in this exciting position.
Manage the Fraud and Abuse Detection System (FADS) Helpdesk and answer FADS related questions and act as a liaison between FADS users and the FADS implementation team
Process all user access requests from the State and maintain a tracking mechanism (Access Database, Excel Spreadsheet, etc.)
Report directly to the California Department of Health Care Services (DHCS) MIS/DSS Liaison to ensure that DHCS Audits & Investigations (A&I) users receive FADS training so they can utilize the application to identify providers and beneficiaries suspected of billing Medi-Cal fraud
Work on the FADS CMS certification and the SURS migration and report recertification projects
Facilitate FADS meetings with local Optum, Optum - Georgia and DHCS staff
Assist with creating algorithms for FADS
Identify system’s enhancements
Identify and develop fraud, wastes and abuse cases utilizing FADS
Verify fraud cases created by OCD team for submission to DHCS MRB unit
Bachelor’s Degree or equivalent experience
2+ years of Program Integrity experience; preferably in Medi-Cal and / or Health Care
2+ years of experience with Business Objects
Experience with medical terms, codes, processes and regulations (i.e. ICD10, CPT, HCPCS)
Excellent customer service skills
Excellent communication and presentation skills
Critical thinking and analytical skills; experience analyzing complex healthcare data preferred
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world?s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
FADS Liaison & Program Integrity Consultant – Sacramento, CA
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About the company
Our mission is to help people live healthier lives and to help make the health system work better for everyone.
A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, we’re doing a lot of good for more than 85 million people worldwide.
Our biggest point of differentiation is our people - and the collective talent, energy, intelligence and drive our force of 188,000 individuals around the world bring to our mission every single day. So, how do we do it? With our every action, interaction and intention that demonstrates the five fundamental values that guide everything we do: