- Fallon Health (Worcester, MA)
- …the Senior Director of Internal Audit in their leadership of the Fraud , Waste and Abuse ( FWA ) program. The FWA Manager will be responsiblefor general ... Assist in the development, implementation and manage strategic fraud , waste and abuse ( FWA ) activities by maintaining state and federal requirements and… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- Position Purpose: The Manager - Fraud , Waste & Abuse ( FWA ) is responsible for day-to-day activities of the FWA Program while meeting operational and ... WorkPlan, and related activities + Detect, investigate and report fraud , waste and abuse cases + Lead special investigations, maintain FWA records,… more
- CVS Health (Hartford, CT)
- …manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse ( FWA ). **Key Responsibilities** + Conduct high level, ... complex investigations of known or suspected acts of healthcare fraud , waste and abuse . + Conduct Investigations to prevent payment of suspect or fraudulent… more
- General Dynamics Information Technology (Fairfax, VA)
- …data-driven solutions to the difficult business challenges of healthcare claims Fraud , Waste and Abuse ( FWA ). This individual will study development and ... reports. These duties will be performed in support of FWA studies using healthcare claims data. **HOW AN ASSOCIATE...DRG and the like). + Experience datamining for healthcare fraud , waste and abuse in… more
- BlueCross BlueShield of North Carolina (NC)
- …Investigations Unit (SIU) is responsible for overseeing and managing fraud , waste , and abuse ( FWA ) detection, investigation, and prevention efforts ... skill sets, cutting edge analytics tools, and robust processes to identify FWA schemes and direct investigations to resolve issues effectively and efficiently. The… more
- CenterLight Health System (NY)
- …ensuring the adherence to DOH and CMS guidelines and to prevent fraud , waste , and abuse ( FWA ). JOB RESPONSIBILITIES: + Treasury responsibilities: + ... and balances for every account across all entities. Identify potential FWA ( fraud , waste and abuse ) and work with key stakeholders to mitigate risks and… more
- Corewell Health (Grand Rapids, MI)
- …Special Investigations Unit (SIU). Responsible for developing and directing the fraud , waste and abuse ( FWA ) program processes and oversight and ... objectives . + Maintains and revises policies and procedures, fraud , waste , and abuse plans,...matters. Represents the SIU in various state and/or federal FWA related regulatory meetings. Ensures that Priority Health meets… more
- CVS Health (Albany, NY)
- …coordinating interdepartmental program integrity initiatives, vendor oversight of fraud waste and abuse ( FWA ) activity, and identifying services ... for compliance with state and federal regulations mandating the reporting of corporate fraud related activities and the preparation of the corporate Anti- Fraud … more
- Centene Corporation (Austin, TX)
- …good faith concerns regarding Medicare non-compliance and potential instances of fraud , waste and abuse ( FWA ) + Responding to reports of potential ... + Maintaining documentation for each report of potential non-compliance or potential FWA received from any source, through any reporting channel or mechanism +… more
- VNS Health (Manhattan, NY)
- …and remediation of issues related to regulatory compliance, privacy, and fraud , waste & abuse ( FWA ). Responsible for reviewing, auditing, and analyzing ... Researches and compiles information on emerging trends, government priorities in fraud / abuse detection, and incorporates information, as appropriate, into audit… more
- Air National Guard Units (Selfridge, MI)
- …Commanders' Inspection Programs (CCIP), as well as the Complaints Resolution, and Fraud , Waste , and Abuse ( FWA ) Programs. Work products impact a wide ... CCIP, Unit Self-Assessment Program (USAP), Complaints Resolution Program (CRP) and FWA Program. Oversees multifaceted IG programs designed to independently assess… more
- CVS Health (Columbus, OH)
- …fraudulent billing practices/schemes and manage complex investigations into suspected fraud , waste , and abuse ( FWA ). + Conduct a comprehensive medical ... Conduct high level, complex investigations of known or suspected acts of healthcare fraud , waste , and abuse . + Documents all appropriate case activity in… more
- Martin's Point Health Care (Portland, ME)
- …and external audits + Provides support for staff involved in investigating Fraud , Waste and Abuse ( FWA ) allegations received via the hotline and other ... USFHP and DHA audits preferred + Previous Compliance, Integrity, FWA or directly related experience preferred Skills/Knowledge/Competencies (Behaviors): + Excellent… more
- SSM Health (Madison, WI)
- …MME, source and DAW to avoid audit charge backs and ensure compliance with Fraud Waste and Abuse ( FWA ) Laws. + Contributes to zero medication errors with ... procedures for quality control and disposal of unusable medications and hazardous waste . Issue controlled substances and maintains records as required by law,… more
- SSM Health (Monroe, WI)
- …MME, source and DAW to avoid audit charge backs and ensure compliance with Fraud Waste and Abuse ( FWA ) Laws. + Contributes to zero medication errors with ... procedures for quality control and disposal of unusable medications and hazardous waste . Issue controlled substances and maintains records as required by law,… more
- CenterLight Health System (NY)
- …outcomes while adhering to CMS and NYS DOH requirements to prevent fraud , waste , and abuse ( FWA ). This position requires working knowledge of health ... care policy and payment methodologies along with strong organizational and analytical skills. JOB RESPONSIBILITIES: Claims payment integrity: + Lead and deliver accurate and timely claims payment integrity analysis, including vendor oversight, to ensure… more
- Air National Guard Units (Belle Chasse, LA)
- …technical expert to wing personnel on the Air Force Complaints Resolution and Fraud , Waste and Abuse ( FWA ) programs and the Air Force Inspection System ... (AFIS). Plans, directs and manages the activities of the Inspector General office, directing the Commander's Inspection Program (CCIP) and overseeing the wing's self-assessment, exercise and inspection programs. Ensures programs comply with legal and… more