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Healthcare Project Manager
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PBACO Holding LLC
Palm Springs, CA (In Person)
Full-Time
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Job Description
Project Manager - Healthcare Fraud, Waste & Abuse Palm Beach Accountable Care Organization (PBACO) | West Palm Beach, FL About Us Palm Beach Accountable Care Organization (PBACO) is one of the nation's top-performing ACOs, committed to improving patient care, reducing costs, and driving innovation in healthcare delivery. As part of our Performance Improvement Team, you will play a critical role in safeguarding healthcare integrity and supporting our mission to deliver high-quality, cost-effective care. The Opportunity We are seeking a detail-oriented and proactive Project Manager - Fraud, Waste & Abuse to lead PBACO's fraud prevention initiatives. In this role, you'll analyze claims data, detect suspicious activity, engage providers, and collaborate with federal and state enforcement agencies. Your work will directly protect patients, prevent fraudulent charges, and preserve the financial health of our ACO. What You'll Do Review Medicare and commercial claims data to detect potential fraud (DME, wound care, genetic testing, etc.). Report suspected fraud to OIG and Safeguard Services in compliance with federal guidelines. Manage provider attestations, ensuring timely responses and escalations when needed. Partner with internal teams to develop fraud detection dashboards and workflows using SQL and BlueSky Analytics. Prepare and submit monthly/quarterly fraud cases and enforcement packages. Stay ahead of emerging fraud schemes through continuous monitoring, research, and process improvement. Provide regular updates to leadership and support cross-functional initiatives that strengthen compliance and efficiency. What We're Looking For Bachelor's degree in Healthcare Administration, Compliance, Data Analytics, or related field. 3+ years of experience in healthcare compliance, fraud prevention, or project management. Familiarity with Medicare regulations, CMS fraud guidance, and enforcement agencies (OIG, UPIC). Strong data analysis skills, with experience in SQL, reporting tools, and MS Office. Exceptional attention to detail, organization, and documentation accuracy. Excellent communication and stakeholder engagement skills with providers and healthcare partners. Preferred Qualifications Experience in an ACO, payer, or healthcare compliance environment. Knowledge of