Manager FWA and Subrogation

Universal Health Services; Reno (NV); In loco; USD 120.000 - 160.000; Tempo pieno

Vantaggi offerti da questo lavoro

Loan forgiveness

Paid time off

Medical coverage

Dental coverage

Vision coverage

401(k) with company match

Student loan refinancing

Career development

Descrizione del lavoro

Prominence Health, part of Universal Health Services, is seeking a Manager of Fraud, Waste, Abuse to lead its FWA, Subrogation, and Payment Integrity programs. You will direct investigations, recoveries, and cost-containment initiatives while collaborating across departments and external partners to ensure compliance and accuracy.

The role emphasizes coordination of benefits, MSP efforts, and timely resolution of opportunities, with focus on data-driven decision-making and regulatory adherence.

Competenze

• Bachelor’s Degree or equivalent in Health-Related Field or Insurance.
• 3–5 years in healthcare such as insurance, medical claims, or contracting.
• Experience in healthcare fraud investigations, auditing, data analytics.
• Ability to apply medical terminology to review claims for coverage decisions.
• Preferred: AHFI, CFE, CPC certifications.
• Ability to manage demanding investigative caseload.
• Strong written and verbal communication skills.
• Experience with MS Office and Smartsheet.
• Confidentiality and compliance with regulations.
• Experience in subrogation operations preferred.

Mansioni

• Lead Prominence’s FWA, Subrogation, Third-Party Liability (TPL), and Payment Integrity programs.
• Provide strategic direction, oversight, and leadership for investigations and recoveries.
• Coordinate ESRD coordination of benefits and MSP initiatives.
• Collaborate across departments and external partners to ensure accuracy and compliance.
• Ensure policies and regulatory requirements are met with timely service delivery.

Conoscenze

Healthcare investigations

Data analytics

Claims review

Regulatory compliance

Investigation workload management

Communication skills

Subrogation knowledge

MSP knowledge

QnXT familiarity

Smartsheet

Formazione

Bachelor’s Degree or equivalent in Health-Related Field or Insurance

Strumenti

Microsoft Office

Smartsheet

Claims processing systems

Descrizione del lavoro

Responsibilities

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Learn more at: https://prominence-health.com/

Job Summary

The Manager of Fraud, Waste, Abuse (FWA) is responsible for leading Prominence’s FWA, Subrogation, Third-Party Liability (TPL), and Payment Integrity programs. This role provides strategic direction, oversight, and leadership to ensure the effective identification, investigation, recovery, and resolution of FWA, TPL, and payment integrity opportunities. Key areas of focus include, but are not limited to, End-Stage Renal Disease (ESRD) coordination of benefits, Medicare Secondary Payer (MSP) initiatives, overpayment recoveries, and other cost-containment and revenue-recovery activities.

The Manager will work collaboratively across departments and external partners, this position ensures compliance with internal policies and all applicable state and federal regulations while maintaining a strong focus on accuracy, quality, financial stewardship, and timely service delivery.

Benefit Highlights

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries! More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington D.C., Puerto Rico and the United Kingdom. www.uhs.com

Qualifications and Requirements

• Bachelor’s Degree or equivalent years of relevant work experience in Health-Related Field or Insurance required
• 3-5 years’ experience in healthcare such as insurance, medical claims, medical front/back office, contracting, finance or Provider Relations
• Experience in healthcare fraud investigations, auditing, data analytics or related field
• Ability to apply knowledge of medical terminology to review claims system for approval or denial of coverage for claims related to accident/illness.
• The following certifications are preferred: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), and Certified Professional Coder (CPC)
• Ability to manage demanding investigative case load
• Strong written skills with ability to compose detailed investigative reports and professional internal and external correspondences
• Strong interpersonal skills, high level of professionalism, integrity and ethics in performance of all duties
• Excellent problem solving and decision-making skills with attention to details
• Experience in working with QNXT or any claim’s processing application is preferred.
• Proficient Computer Skills: Microsoft Office (Word, Excel, PowerPoint, Outlook), Smartsheet
• Strict adherence of rules and regulations for confidentiality and compliance.
• Excellent time management skills with proven ability to meet deadlines.
• Previous experience in subrogation operations preferred.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.