- Elevance Health (Seattle, WA)
- ** Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role enables associates to work ... to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Fraud Investigator II** is responsible for...and Experiences:** + Fraud and Abuse experienced Nurse with a CPC are highly desired.… more
- UPMC (Pittsburgh, PA)
- …equivalent combination of education, professional training and work experience. Five years of clinical experience. Three years of fraud & abuse, auditing, case ... UPMC Health Plan has an exciting opportunity for a Clinical Auditor/Analyst Intermediate! The Clinical Auditor/Analyst Intermediate...of unlisted codes. Claims analysis and the use of fraud and abuse detection software tools will be an… more
- Zelis (St. Petersburg, FL)
- …claims preferred + Current, active Outpatient Coding Certification required (such as CPC , CCS, or equivalent credentialing). + Registered Nurse licensure ... are. Position Overview At Zelis, the Itemized Bill and Clinical Chart Dispute Reviewer role is responsible for the...WhatsApp or personal emails for recruitment. Forward any suspected fraud to ###@zelis.com for prompt investigation. Thank you for… more
- Magellan Health Services (Boise, ID)
- …Accredited Healthcare Fraud Investigator - EnterpriseEnterprise, CFE - Certified Fraud Examiner - EnterpriseEnterprise, CPC - Certified Professional Coder - ... This position is responsible for comprehensive management and ownership of fraud , waste and abuse investigations including development and presentation of… more
- Veterans Affairs, Veterans Health Administration (Orlando, FL)
- …AAPC and two years of experience in clinical documentation improvement; OR, Clinical experience, such as Registered Nurse (RN), Medical Doctor (MD), or ... for abstracting medical record data and assigning codes using current clinical classification systems appropriate for the type of care provided. Responsibilities… more