- Elevance Health (Columbus, OH)
- ** Clinical Fraud Investigator II** **Location: This position will work in a hybrid model (remote and office). The ideal candidate must live within 50 miles ... listed in the requisition.** **Work schedule: M-F normal business hours** The ** Clinical Fraud Investigator II** is responsible for identifying issues and/or… more
- Kelsey-Seybold Clinic (Pearland, TX)
- **Responsibilities** The Sr. Fraud Investigator SIU (Special Investigations Unit) assists in the implementation and daily operation of the organization's ... to all audits and investigations conducted **Job Title: Sr. Fraud Investigator (SIU)** **Location: Pearland Administrative Office**...quality patient care by adding to our team of clinical and non- clinical professionals that work together… more
- Providence (CA)
- …in health care fraud investigation, such as Accredited Healthcare Fraud Investigator (AHFI), Certification as an Internal Auditor (CIA), Healthcare ... people, we must empower them._** **Providence Health Plan is calling an Investigator , Special Investigation Unit who will:** + Support timely completion of… more
- State of Georgia (Fulton County, GA)
- …Job Alerts The Office of the Attorney General Georgia Department of Law Nurse Investigator - Medicaid Fraud Division *To move forward in the recruiting process ... Nurse Investigator Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/51086/other-jobs-matching/location-only) Hot...will serve within the Audits section of the Medicaid Fraud Division. Job Summary Under the direction of the… more
- Molina Healthcare (Owensboro, KY)
- **JOB DESCRIPTION** **Job Summary** The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical ... records to document relevant findings of a post pay clinical review. This position manages documents and prioritizes case...of experience working in a FWA / SIU or Fraud investigations role for New Jersey/New York location +… more
- CareFirst (Baltimore, MD)
- …the prevention, reduction of and/or recuperation of losses to CareFirst through the clinical review of medical records and claims, resulting in the savings and/or ... recovery of funds. Responsible for providing clinical knowledge to the SI team to support both...Review of medical records and claims. + Investigate potential fraud and over-utilization by performing complex medical reviews of… more
- Bausch + Lomb (Columbus, OH)
- …Activities/Responsibilities:** + Leads or collaborates on required tasks prior to commencement of clinical trials that include, but are not limited to: clinical ... protocol development, case report form (CRF) development, IRB submissions, investigator agreements, informed consent form (ICF) development, site selection and… more
- Bausch + Lomb (Irvine, CA)
- …the future. Bausch + Lomb's R&D organization is seeking an experienced clinical development professional serving the Pharmaceutical and Consumer portfolio at Bausch ... see better to live better. This is an opportunity for a highly motivated clinical development scientist to be a key strategic contributor to shaping the future of… more
- Bausch + Lomb (Rochester, NY)
- …of the Director, Clinical Research and the direction of the Principal Investigator (PI). While the PI is primarily responsible for the overall design, conduct, ... advancement of eye health in the future. **Position Objectives** A Senior Clinical Research Coordinator (Sr. CRC) is a specialized medical research professional… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …Nursing, Criminal Justice, or similar field of study preferred. + Accredited Healthcare Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE) ... and refer to law enforcement as appropriate incidents of fraud , waste, and abuse (FWA) arising in connection with...anti-FWA efforts in collaboration with Payment Integrity, Operations, Legal, Clinical , and IT teams, and will leverage your own… more
- Bausch + Lomb (Seattle, WA)
- …the practice of their colleagues. + Identify unsolicited requests for investigator -initiated research. + Where appropriate, provide overall medical / scientific ... support through the dissemination of on-label educational, scientific, and clinical information on diseases and treatments. + Where appropriate, respond to… more
- Mount Sinai Health System (New York, NY)
- …+ Strong customer service skills + Ability to communicate effectively with clinical , business and administrative staff + Excellent written and oral communication ... on pre-determined selected charges + Follow-up with providers regarding missing clinical documentation which is required to complete accurate coding and billing… more
- Olympus Corporation of the Americas (Center Valley, PA)
- …investigations process and capabilities worldwide; including designing and delivering investigator /case manager training for l colleagues throughout the Olympus ... relevant experience is required + Demonstrated ability to understand and apply fraud and abuse, anti-kickback and other rules and regulations applicable to medical… more