Wayne Fisher
Manager II, Investigations at Anthem, Inc.
- Role
- Manager, Investigations at Anthem, Inc
- Location
- Nashville, TN, US
- LinkedIn followers
- 500 followers
About Wayne Fisher
Investigations Manager and ACFE Certified Fraud Examiner experienced in quickly…
Experience
Manager, Investigations
Aug 2018 — Present · Nashville, TN, US
Supervises and coordinates the investigations of alleged Medicare fraud- Coordinates the analysis of provider utilization patterns and trends and of provider billing and financial data an supervises the case inventory to include monitoring of aging and priority- Oversees the integration of various computer systems in the Unit, to include monitoring of aging and priority- Coordinates the review of documentation to ensure validity and applicability of data, the preparation of written summaries of the investigations, and the development of cases to be referred to the Office of the Inspector General (OIG)- Continually communicates with CMS, OIG, and Department of Justice regarding current fraud trends, current case issues, and current analyses and training opportunities- Actively participates in ISO Certification renewal, proposals and transitions of additional PSC business and serves as a lead for specified functions- Keeps abreast of changes in Medicare benefits, policies and regulations and in CMS performance standards and assists management in the interpretation of Medicare policies and procedures- Works in conjunction with the Quality Management Supervisor to maintain a quality assurance and improvement program that is in accordance with the ISO Quality Management System- Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Education
LSU Shreveport
Master of Business Administration - MBA
University of Alabama
Bachelor's Degree
1991 — 1996
Skills
- Pmbok
- Claim Investigation
- Multi Tasking
- Criminal Law
- Forensic Analysis
- Medical Research
- Telephone Interviewing
- Criminal Investigations
- Government
- Microsoft Office
- Business Coaching
- Microsoft Office 2007
- Medicare/Medicaid Reimbursement
- Public Speaking
- Durable Medical Equipment
- Management
- Federal Healthcare
- Legal Research
- Agenda Development
- Statistical Data Analysis
- Performance Management
- Insurance Fraud
- Team Leadership
- Legal Writing
- Cross-Functional Team Leadership
- Certified Fraud Examiner
- Data Analysis
- Fraud
- Professional Mentoring
- Project Management
- Fraud Detection
- Performance Metrics
- Behavioral Interviewing
- Data Analytics
- Medical Billing
- Medical Devices
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