Ronald Lee

Siu Manager @Molina Healthcare

Long Beach, CA, US

Oversight, supervision, and leadership of a team of SIU Investigative staff tasked to prevent, detect, investigate, and report cases of suspected Fraud, Waste and Abuse (FWA) across all lines of business in over 18 individual state Health Plans and Medicare lines of business.Collaboration with all internal and external departments across Molina Health Incorporated (MHI) in order to ensure compliance with regulatory standards and requirements, contractual obligations, and federal and state laws. Overseeing the execution of individual state FWA plans through effective SIU investigative activities, including data analysis, member and provider interviews, identification and recoupment of overpayments related to FWA, and appropriate referrals to law enforcement and/or appropriate state regulatory agencies. Continuous collaboration with MHI Medical Management staff, Enterprise Information Management, and FWA Solutions vendors to identify potential FWA concerns across MHI. Planning, developing, and implementing processes, policies, and desktop procedures to ensure compliance program effectiveness and payment integrity. Planning, development, and execution of proactive audit and monitoring activities in order detect potential FWA concerns.

National University

Master of Business Administration (MBA), Business Administration and Management, General

UC Irvine

Bachelor's degree, Social Ecology