Supervisor - Audit/Investigation
Qlarant · Dallas, TX · 4 wk ago
On-siteAccountingFull-time
We need to output HTML fragment with headings for sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. No job title heading. No Job ID etc. Remove boilerplate like EEO, drug-free workplace, etc. Also remove application instructions (none present). Need to preserve all substantive info.
Let's parse the posting.
First paragraph: "Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for underserved communities. Best People, Best Solutions, Best Results"
That's about the company. Could be "About the role"? Actually "About the role" is about the job, not company. But we have no explicit "About the role" section. However we could treat the company description as "About the role"? The instruction: use
inside
for sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. No job title heading. No Job ID etc. Remove boilerplate like EEO, drug-free workplace, etc. Also remove application instructions (none present). Need to preserve all substantive info.
Let's parse the posting.
First paragraph: "Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for underserved communities. Best People, Best Solutions, Best Results"
That's about the company. Could be "About the role"? Actually "About the role" is about the job, not company. But we have no explicit "About the role" section. However we could treat the company description as "About the role"? The instruction: use for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). It says e.g., meaning those are examples; we should include sections only when posting has real specific content for it. The posting includes a "Job Summary:" which could be considered "About the role". Also there is "Essential Functions:" which is responsibilities. Then "Level of Supervision Received:" etc. Then "Education (can be substituted for experience):", "Work Experience (can be substituted for education):", "Certification(s):". Those map to Requirements/Qualifications/Skills perhaps.
We need to decide sections:
- About the role: could include Job Summary and maybe company description? The posting includes "Job Summary: Oversees audits/investigations..." That's a summary of role. So we can put that under About the role.
- Responsibilities: Essential Functions list (many bullet-like sentences). We'll turn each sentence into
- .
- Requirements: Education and Work Experience maybe.
- Qualifications: Certification(s) maybe.
- Skills: Not explicitly listed; maybe we could infer from responsibilities but we shouldn't invent. So we skip Skills if no explicit content.
- Benefits, Pay, Schedule: Not mentioned; skip.
We must not include sections with placeholder text like "commensurate with experience". Not present.
We must remove boilerplate: EEO statement, drug-free workplace, contingent upon background check. Those lines at end: "Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities. Qlarant is a drug-free workplace. All offers of employment are contingent upon successful completion of pre-employment background and drug screens." Remove.
Also remove any duplicated lines (none seen). Also remove cookie/navigation/legal etc (none).
Now produce HTML fragment.
Structure:
- for any list of duties/requirements/benefits". The essential functions are a list; we can break them into items at each semicolon and period. Let's produce items for each distinct duty.
Let's list:
1. Reviews new audits/investigations and/or incoming leads to determine appropriateness and assigns to auditors/investigators
2. Vets providers as required with appropriate agency(ies) and law enforcement
3. Supervises vetting process
4. Reviews audit/investigation plans and priorities to ensure appropriateness and quality for the specific functions/workload assigned to team
5. Conducts file reviews regularly of audits/investigations to ensure audit/investigation plan is appropriate and the audit/investigation file documents are entered and summarized within the case tracking systems appropriately
6. Reviews auditor/investigator requests for information, data, reports, and correspondence to ensure quality and appropriateness
7. Supervises and conducts audit/investigation actions such as interviewing, onsite audit/investigation, and/or site verification as needed
8. Leads audit/investigation projects including developing an audit/investigation strategy, conducting meetings with stakeholders, reviewing project actions for quality, and documenting findings in reports for management
9. Communicates with the Data and Medical Review departments to ensure efficient audits/investigations
10. Prepares and presents audits/investigations, overpayments, and questions for stakeholder meetings
11. Documents audit/investigation information and file reviews (interviews, events, findings, communications, etc.) into the case tracking systems and updates systems as needed
12. Determines audit/investigation appropriateness of fraud, waste, and abuse issues in accordance with pre-established criteria
13. Reviews audit/investigative findings with auditors/investigators and approves course of action
14. Supervises and prepares team’s audits/investigations for the Major Case Coordination meetings and reviews for quality assurance
15. Initiates and maintains communications with law enforcement and appropriate regulatory agencies including presenting or assisting with presenting audit/investigation findings for their consideration to further audit/investigate, prosecute, or seek other appropriate regulatory or administrative remedies
16. Supervises administrative remedies in accordance with major case coordination direction (e.g. payment suspensions, revocations, provider education) and reviews for quality assurance
17. Reviews and approves closing summary of audit/investigation
18. Collects information and documentation as requested by internal and external stakeholders (e.g. CMS, law enforcement, FOIA requests) and submits, as required
19. Collaborates with other program integrity contractors, as needed
20. Testifies at various legal or administrative proceedings, as necessary
21. Manages team performance through regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development
Now Requirements: Education and Work Experience.
Education: Minimum Bachelor's Degree required (can be substituted for experience). We'll phrase: Minimum Bachelor's Degree required (education can be substituted for experience).
Work Experience: 5 - 7 years of experience required; 8 - 11 years preferred.
We could combine into Requirements section.
Qualifications: Certification(s): Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator Certification preferred.
We could put under Qualifications.
Skills: Not present; skip.
Benefits, Pay, Schedule: none.
Now ensure we don't include boilerplate.
Now produce HTML.
We'll wrap each section in
and then
or
- .
For About the role:
- ... each item
- Minimum Bachelor's Degree required (education can be substituted for experience)
- 5 - 7 years of experience required; 8 - 11 years preferred
- Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator Certification preferred
Job Summary: 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 or cases compliance cases (e.g. Medicare and/or Medicaid) that meet established criteria for referral to the appropriate agency(ies) for administrative action or to law enforcement for criminal action.
For Responsibilities:
About the role
Job Summary: 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 or cases compliance cases (e.g. Medicare and/or Medicaid) that meet established criteria for referral to the appropriate agency(ies) for administrative action or to law enforcement for criminal action.
But note: The Job Summary sentence is long; we can keep as is. Alternatively we could incorporate the company description into About the role? The instruction says "About the role" heading for section headings (e.g. About the role, Responsibilities...). It didn't forbid including company description there, but better to keep to role summary. The company description is not about the role but about the company; maybe we could put it under About the role as context? However the instruction says "use