Director Financial Investigations & Provider Review - Highmark : Job Details

This job is responsible for the execution of the strategic plan of the Financial Investigations & Provider Review (FIPR) organization. The strategic plan focuses on the detection and investigation of fraud, waste and abuse (FWA) and recoupment of related overpayments associated with the companys provider spending. The incumbent will function as a champion and driving force in the development of hospital/facility reimbursement related strategies to audit, educate, and secure financial recoveries when necessary, and/or to develop action plans for cases referred to law enforcement, if applicable. ESSENTIAL RESPONSIBILITIES Performs management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plans, organizes, staffs, directs and controls the daytoday operations of the department; develops and implements policies and programs as necessary; may ...Director, Financial, Healthcare, Operations, Waste, Audit, Business Services