- Guidehouse (New York, NY)
- …Will Do** **:** Guidehouse has an aggressive growth strategy for its Healthcare Fraud , Financial Crime, Compliance, and Investigative Services (FFI-Health) team. ... FFI-Health is currently seeking candidates with relevant healthcare fraud , waste, and abuse (FWA), regulatory compliance, and/or investigations experience (eg,… more
- AmeriHealth Caritas (Dublin, OH)
- **Special Investigator ( Healthcare Fraud , Waste & Abuse)- Ohio resident** Location: Dublin, OH Primary Job Function: Compliance ID**: 34748 **Job Brief** This ... be required to make Ohio provider visits as needed. Healthcare SIU / FWA experience required. Your career starts...for conducting comprehensive investigations of reported, alleged or suspected fraud involving the full range of products at the… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …waste and abuse schemes. + Support the Medicare compliance program by overseeing Medicare fraud waste and abuse activity in FIP, work with the Pharmacy ... Ready to help us transform healthcare ? Bring your true colors to blue. Blue...fraud waste and abuse work, present to the Medicare Compliance Committee and manage requests and audits from… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …claims examination, adjusting, fraud detection, or investigations in a healthcare environment. Preferred: Strong knowledge of Medicare Advantage Medicare ... The SIU Investigator will be responsible for identification, investigation and prevention of healthcare fraud , waste and abuse. The primary responsibility of the… more
- Molina Healthcare (Owensboro, KY)
- …The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses ... of experience working in a FWA / SIU or Fraud investigations role for New Jersey/New York location +...to health insurance, investigations & legal processes (Commercial insurance, Medicare , Medicare Advantage, Medicare Part… more
- KPH Healthcare Services, Inc. (Concord, NH)
- …services to more than 50,000 residents. HealthDirect is a division of KPH Healthcare Services, a billion dollar, 100% employee owned provider of pharmaceutical and ... healthcare services. KPH is comprised of four divisions -...related field **Experience:** + Preferred: 1 to 2 years Medicare billing + Preferred: General knowledge of Medicare… more
- Prime Healthcare (Ontario, CA)
- Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 ... nearly 50,000 employees and physicians. Fourteen of the Prime Healthcare hospitals are members of the Prime Healthcare...the Antikickback Statute, the False Claims Act, and other Fraud , Waste and Abuse laws and regulations, along with… more
- Fallon Health (Worcester, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... Attend and participate in workgroups, committees, or projects. + Research potential fraud , waste or abuse related inquires. **Primary Job Responsibilities** + Assist… more
- KPH Healthcare Services, Inc. (Syracuse, NY)
- …plans and any changes that possibly may occur within the Insurance Payor, Medicare , or Medicaid + Responsible for completing all mandatory and regulatory training ... **Required Training:** + HIPAA Privacy & Security Course + Fraud , Waste, and Abuse Course **Job Skills Required:** +...as relevant skills, years of experience, and education. KPH Healthcare Services, Inc. is a multistate organization and abides… more
- State of Georgia (Fulton County, GA)
- …Georgia Medicaid Program. Participates as a member of an interdisciplinary team in Healthcare fraud investigations, and provides support to members of other ... services and eligibility of providers as requested. + Assists prosecutors in Healthcare Fraud investigations by reviewing provider and patient records. +… more
- University of Rochester (Rochester, NY)
- …assisted living communities. This includes, but is not limited to: fraud and abuse, billing compliance, corporate transactions, physician employment and ... Health Sciences, researches, analyzes, and provides regulatory compliance advice on the Fraud and Abuse Laws, including, but not limited to, the Anti-Kickback… more
- PruittHealth (Atlanta, GA)
- …them effectively to providers, potential members and key decisions makers. * Complete annual Medicare Fraud , Waste and Abuse Training and Model of Care Training ... experience required, with strong preference for candidates with previous experience in Medicare or healthcare sales and engagement. Previous experience in case… more
- Billings Clinic (Billings, MT)
- …all aspects of the net patient revenue accounting, preparation of the Medicare and Medicaid cost reports (including maintaining models and providing decision ... best practices for reimbursement functions across all enterprise entities, including Medicare Cost Reporting, monthly and annual financial reporting, required state… more
- Immigration and Customs Enforcement (IN)
- …Health Service Corps (IHSC), Division, Office of Deputy Assistant Director of Healthcare Compliance, Office of Health Plan Management. This is a supervisory ... IHSC policies, VA Financial Services Center (VAFSC) Business Requirements, Medicare reimbursement requirements, referral management, and evidence-based utilization management… more
- Commonwealth Care Alliance (Boston, MA)
- …compliance. + Works closely with the Governance, Risk & Compliance (GRC) teams ( Medicare , Medicaid, Privacy, Fraud , Waste & Abuse) for dissemination of new ... perform compliance oversight and monitoring of delegated third parties including Medicare FDR; Duals/SNP; and Medicaid/LTSS programs. + Coordinates and reviews work… more
- McLaren Health Care (Indianapolis, IN)
- …risk arrangements._ + _Certification as a Certified Fraud Examiner (CFE), Certified Professional Medical Auditor or Accredited Healthcare Fraud Investigator_ ... working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier...of related experience. + Three (3) years' experience in fraud , waste, and abuse audits and/or investigations; internal audits… more
- State of Colorado (Aurora, CO)
- …CBI name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure ... Accountant I you can expect to: + Bills Medicaid, Medicare , VA, private pay, hospice, and associated supplemental plans...A/P software 09 Please describe any experience working with healthcare or medical vendors, and invoice coding as it… more
- Covenant Health Inc. (Knoxville, TN)
- …inpatient and out-patient and/or physician practice. Good working knowledge of healthcare billing, Medicare /Medicaid billing guidelines, and other Third Party ... Covenant Health Overview: Covenant Health is the region's top-performing healthcare network with 10 hospitals (http://www.covenanthealth.com/hospitals/) , outpatient and… more
- VNS Health (Manhattan, NY)
- …regulations. Works with Compliance and Special Investigation Unit on issues related to Fraud , Waste, and Abuse of Medicare /Medicaid services. + Ensures that ... every day brings new challenges and opportunities to make a difference in healthcare ! Your role is more than just administration; it's about pioneering medical… more
- State of Massachusetts (Boston, MA)
- …Program Integrity Director is responsible for leading MassHealth's efforts to control fraud , waste and abuse ("FWA") across the agency's programs. The Deputy ... focus on predicting, detecting, preventing, and deterring inappropriate payments to healthcare providers. The Deputy Director is ultimately accountable for executing… more