2 counter threat finance analyst jobs found in Detroit

COMPLIANCE SPECIALIST     Under the general supervision of the Vice President of Compliance & Privacy Officer, the Compliance Specialist is responsible for conducting investigations and audits related to fraud, waste, and abuse within the DWIHN provider network. This role includes performing targeted reviews, gathering and analyzing information, and applying relevant regulations, policies, and internal controls to assess compliance. The Compliance Specialist also supports the implementation of policies, procedures, and control measures to ensure that DWIHN and its providers adhere to applicable regulatory and ethical standards.   PRINCIPAL DUTIES AND RESPONSIBILITIES:   Conduct FWA Investigations: Manage investigations related to suspected fraud, waste, and abuse within the provider network. Data Gathering & Analysis: Collect, review, and analyze relevant documents, data, claims, medical records, and other evidence to assess compliance...

Under the supervision of the Director of Managed Care Operations, the Provider Network Manager is responsible for the overall coordination of the contracts between the Detroit Wayne Integrated Health Network (DWIHN) and the assigned network providers.   PRINCIPAL DUTIES AND RESPONSIBILITIES: Manages the contracts between (DWIHN) and the assigned network providers.   Serves as the primary liaison between the Network and the providers. Leads a “virtual team” of interdepartmental experts to assist, monitor and manage the network providers Collaborates with Finance, Information Technology, Recipient Rights, Quality Management, and Clinical Services to ensure that all contractual issues/concerns are addressed.   Serves as the providers primary point of contact with the Network.  Facilitates the successful implementation of new contracts with providers by providing technical assistance. Monitors, assesses and ensures that providers receive required and necessary training....