Senior Supervisor managing plasma receipt, storage, inventory, and distribution for Grifols, a global healthcare company. Supervising teams, compliance, SOPs, training, and resource planning in Montreal.
About the role
- Supervisor managing audit and investigation workload related to Medicare fraud prevention. Leading teams, reviewing plans, and ensuring quality of investigations.
Responsibilities
- Oversees audits/investigations and audit/investigation workload
- Performs in-depth evaluation and makes field level judgments related to audits/investigations of potential Medicare fraud waste and abuse audits/investigations
- Reviews new audits/investigations and/or incoming leads to determine appropriateness and assigns to auditors/investigators
- Reviews audit/investigation plans and priorities to ensure appropriateness and quality for the specific functions/workload assigned to team
- Conducts file reviews regularly of audits/investigations
- Reviews auditor/investigator requests for information, data, reports, and correspondence
- Supervises and conducts audit/investigation actions such as interviewing, onsite audit/investigation, and/or site verification as needed
- Leads audit/investigation projects including developing an audit/investigation strategy
- Communicates with the Data and Medical Review departments to ensure efficient audits/investigations
- Prepares and presents audits/investigations, overpayments, and questions for stakeholder meetings
- Documents audit/investigation information and file reviews into the case tracking systems
- Determines audit/investigation appropriateness of fraud, waste, and abuse issues in accordance with pre-established criteria
- Reviews audit/investigative findings with auditors/investigators and approves course of action
- Supervises and prepares team’s audits/investigations for the Major Case Coordination meetings
- Initiates and maintains communications with law enforcement and appropriate regulatory agencies
- Supervises administrative remedies in accordance with major case coordination direction
- Reviews and approves closing summary of audit/investigation
- Collects information and documentation as requested by internal and external stakeholders
- Collaborates with other program integrity contractors
- Testifies at various legal or administrative proceedings
- Manages team performance through regular, timely feedback as well as the formal performance review process
Requirements
- Minimum Bachelor's Degree required
- 5 - 7 years of experience required; 8 - 11 years preferred
- Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator Certification preferred
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