Fraud Waste and Abuse Education Manager

Fraud Waste and Abuse Education Manager

Full-time Remote Employment

Who We Are:

Constellation Quality Health is a non-profit health care quality consultancy and QIO-like Entity certified by Centers for Medicare and Medicaid Services (CMS) founded by physicians in 1983. Headquartered in North Carolinas Research Triangle we offer an array of quality improvement clinical review audit technical and consulting services and solutions to improve care delivery system performance and patient outcomes.

What Youll Do:

The Education Manager is responsible for developing implementing and maintaining the Contractors Outreach and Education Plan in accordance with state and federal Medicaid requirements. This role will lead provider education initiatives to promote compliance with program policies audit protocols and clinical best practice standards. The Education Manager will serve as a primary liaison to provider communities delivering targeted education to reduce overpayment and underpayment rates while strengthening provider understanding of Medicaid rules and expectations.

We expect you to:

• Develop implement and maintain a comprehensive Provider Outreach and Education Plan in accordance with contractual and Medicaid program requirements.
• Plan coordinate and conduct remote and in-person provider education sessions workshops and webinars to improve compliance with Medicaid policies audit protocols and documentation standards.
• Prepare and submit educational materials presentations and talking points for Department review and approval within required timeframes; incorporate feedback prior to distribution or delivery.
• Track and maintain education metrics including attendance satisfaction follow-up actions and impact on provider performance to support contract deliverables and continuous quality improvement.
• Identify and analyze provider trends recurring errors and aberrant billing behaviors that indicate the need for targeted education and develop corresponding training strategies.
• Collaborate with audit data analytics and policy teams to ensure educational content aligns with current Medicaid rules regulations and audit findings.
• Represent the organization at provider association meetings stakeholder sessions and Department-requested presentations communicating program methodologies audit results and recommendations to reduce payment error rates.
• Respond to provider inquiries regarding audit findings overpayment notifications and educational resources ensuring professionalism and sensitivity when addressing resistant or dissatisfied providers.
• Maintain organized documentation of all outreach and education activities including schedules materials correspondence and approvals in accordance with contract and record retention requirements.
• Supervise and mentor education team members ensuring alignment with program objectives consistent messaging and adherence to Department-approved materials.
• Support the Director and leadership team with budget oversight workload prioritization and reporting to ensure education program activities remain timely cost-effective and compliant.
• Contribute to the development of program manuals policies and proposals providing input related to provider education outreach strategy and stakeholder engagement.
• Demonstrate strong public speaking writing and presentation skills ensuring educational content is clear accurate and tailored to provider audiences of varying backgrounds and disciplines.

Candidates will primarily work remotely; however travel is required for provider meetings conferences or Department-requested presentations as needed.

Our requirements for this role:

• Associates degree required in Nursing Health Administration Public Health Education or a related healthcare field with a minimum of ten (10) years of directly related experience.
• At least five (5) years of experience in healthcare education provider relations compliance or Medicaid program operations.
• Demonstrated experience conducting provider training outreach or public speaking engagements in a healthcare setting.
• Strong knowledge of Medicaid regulations billing practices and clinical documentation standards.
• Supervisory or management experience required; experience leading education or outreach teams preferred.
• Professional credentials such as Certified Program Integrity Professional (CPIP) Certified Fraud Examiner (CFE) Certified Professional Coder (CPC) Certified Professional Medical Auditor (CPMA) or other relevant certification preferred.
• Proficiency in Microsoft Office Suite (Word Excel PowerPoint Outlook) web-based meeting platforms and SharePoint.
• Excellent communication interpersonal and presentation skills with the ability to adapt messages for diverse provider audiences.
• Experience in program evaluation continuous quality improvement and tracking performance metrics preferred.

Why Constellation Quality Health

We offer a competitive salary and benefits package and a flexible supportive hybrid work environment.

Salary Range: $80000 - $90000 annually

Benefits: Health dental and vision insurance; 401(k) with employer match; paid holidays and PTO.

Equal opportunity employer of protected veterans

Equal opportunity employer of individuals with disabilities

We do not discriminate on the basis of race ancestry color religion sex age marital status sexual orientation gender identity national origin medical condition disability veteran status or any other basis protected by law.

Applicants and employees are protected from discrimination based on inquiring about disclosing or discussing compensation or the compensation of other applicants or employees.