Fraud Waste and Abuse Education Manager na The Carolinas Center for Medical Excellence

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 Carolina�s 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 You�ll Do:

The Education Manager is responsible for developing, implementing, and maintaining the Contractor�s 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:

• Associate�s 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: $80,000 - $90,000 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.