Required: * Bachelor\'s Degree from 4-year college or university AND 2-4 years related experience & /or training; OR equivalent combination of education & experience * Computer skills: use various applications including database, spreadsheet, report writing, project management, graphics, word processing, presentation creation/editing, communicate by e-mail & use scheduling software Preferred: * Certified Internal Auditor (CIA) or Certified Professional Coder (CPC) Summary: This position is responsible for coordinating the day-to-day responsibilities of the Fraud, Waste, & Abuse program in compliance with the rules & regulations of the Oregon Health Authority, State of Oregon, & the Federal Government Healthcare Programs. This position works with the Compliance Officer on audits, policies & procedures, training, & regulatory reporting. Essential Duties: 1. Maintains a program that identifies & prevents Fraud, Waste, & Abuse 2. Writes & maintain internal documents, processes, & policies & procedures related to the Fraud, Waste, & Abuse Program 3. Plans & conducts billing & coding audits, policy & procedure audits, training audits, & investigation related to the Fraud, Waste, & Abuse Program 4. Completes required regulatory reporting timely & accurately Duties Include: * Develops audit work plans & performs auditing & monitoring consistent with the plan * Reviews materials submitted including policies, sample files, program documentation & other materials relevant to the audit protocol * Coordinates with other departments & agencies to facilitate detection, prevention, & referrals of potential Fraud, Waste, & Abuse * Initiates & maintains communications with appropriate regulatory agencies including presenting or assisting with presenting investigation or case findings for their consideration to further investigate, prosecute, or seek other appropriate regulatory or administrative remedies * Testifies at various legal proceedings as necessary * Facilitates the recovery of funds lost as a result of fraud, waste, & abuse matters * Creates & delivers training to staff designed to promote deterrence & detection of fraud, waste, & abuse * Participates in the annual risk assessment to identify & evaluate delegation risk as part of the Enterprise Risk Management program * Conducts Fraud, Waste, & Abuse investigations & documents case activity appropriately, working with subcontractors as needed * Participates in preparation & response to regulatory audits * Stays current with regulatory requirement through reviews of periodicals, compliance association newsletters & review of state & federal regulatory agency web sites, publications & contracts * Maintains confidentiality & compliance with HIPAA rules & regulations * Maintains punctual, regular & protectable attendance * Works collaboratively in a team environment with a spirit of cooperation * Displays excellent communication skills including presentation, persuasion, & negotiation skills required in working with members & coworkers