- MyFlorida (Miami, FL)
- …provides analytical support for attorneys and investigators in Florida-specific and multistate health care fraud investigations and litigation matters. An ... investigative information relating to alleged violations of applicable laws pertaining to health care fraud , in the administration of the Medicaid program,… more
- Molina Healthcare (AZ)
- …**Preferred Education** * Master's degree **Preferred Experience** * Formalized training/experience in Health Care Insurance Fraud * Experience with Power ... escalations are achieved. Coordinates with both the Associate Vice President of Fraud , Waste and Abuse (FWA) and Associate Vice President of Special Investigations… more
- CVS Health (Columbus, OH)
- …situation. **Education** + Bachelor's degree or equivalent experience (3-5 years of working health care fraud , waste and abuse investigations). **Pay Range** ... Certified Fraud Examiners (CFE), or an accreditation from the National Health Care Anti- Fraud Association (AHFI) + Knowledge of Aetna's policies and… more
- AmeriHealth Caritas (Columbia, SC)
- …and sequential thinker. + A minimum of 3-5 years experience conducting comprehensive health care fraud ;investigations; interacting with state, federal and ... now. We are looking for the next generation of health care leaders. At AmeriHealth Caritas, we...for conducting comprehensive investigations of reported, alleged or suspected fraud involving the full range of products at the… more
- State of Georgia (Fulton County, GA)
- …of our Medicaid Fraud Division. Duties & Responsibilities: Investigators conduct health care fraud investigations. Assists criminal justice personnel, ... including, but not limited to, Analysts, Auditors, and Prosecutors in conducting on-site health care fraud and patient abuse investigations. May be issued a… more
- Molina Healthcare (Miami, FL)
- …prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud , waste, and abuse. Duties include ... Services, Claims) to gather documentation pertinent to investigations. + Detects potential health care fraud , waste, and abuse through the identification of… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …will be a dedicated coding specialist reviewing medical records to identify instances of health care fraud , waste, and abuse and to facilitate accurate ... of medical records and applicable documentation to identify potential fraud , waste, and abuse and inappropriate billing practices. 3....adjudication by health insurers + Knowledge of health care delivery systems with an emphasis… more
- Molina Healthcare (Meridian, ID)
- …prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud , waste, and abuse. Duties include ... Services, Claims) to gather documentation pertinent to investigations. * Detect potential health care fraud , waste, and abuse through the identification of… more
- Executive Office for US Attorneys and the Office of the US… (Atlanta, GA)
- …most often brought for the United States under the False Claims Act and involve allegations of health care fraud , procurement fraud , grant fraud and ... seeks recovery of government funds fraudulently obtained, litigates affirmative civil fraud and enforcement actions, and defends the US Government's interest in… more
- Molina Healthcare (KY)
- …prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud , waste, and abuse. Duties include ... Services, Claims) to gather documentation pertinent to investigations. * Detect potential health care fraud , waste, and abuse through the identification of… more
- CACI International (Washington, DC)
- …Management Analyst (DMA) to support and work closely with the Department of Justice, Health Care Fraud Division attorneys in a fast-paced setting and ... Document Management Analyst (DMA) role works closely with the Department of Justice, Health Care Fraud Division attorneys in a fast-paced setting and assist… more
- Fox Rothschild LLP (Sarasota, FL)
- …Abilities:** + Experience with complex health care transactions. + Experience with health care compliance and fraud and abuse matters is preferred. + ... Corporate ( Health Care Regulatory) Associate - Sarasota **Description:** With bold growth in recent years, Fox Rothschild brings together 1,000 attorneys coast… more
- CACI International (Washington, DC)
- …The Document Management Analyst (DMA) role works closely with the Department of Justice, Health Care Fraud Division attorneys in a fast-paced setting and ... and administrative duties as requested by attorneys for Fraud Section ( Health Care Fraud division) investigations and trials. + Assist with case… more
- Executive Office for US Attorneys and the Office of the US… (Houston, TX)
- …and procedural matters, and sentencing issues. The appeals arise from diverse crimes, such as health care fraud , mortgage fraud , other complex fraud ... includes, in part, paid vacation; sick leave; holidays; telework; life insurance; health benefits; and participation in the Federal Employees Retirement System. The… more
- Hartford HealthCare (Hartford, CT)
- …emphasis on health law regulatory matters * Knowledge of federal and state health care regulations, including Fraud & Abuse, Stark, Anti-Kickback, HIPAA, ... on regulatory matters related to a transaction, regulatory enforcement, and health care compliance matters, including licensing issues, Connecticut Certificate… more
- Molina Healthcare (WI)
- …by overseeing, follow-up and resolution of investigations. **KNOWLEDGE/SKILLS/ABILITIES** + Detects potential health care fraud , waste, and abuse through the ... understands and complies with applicable laws and regulations pertaining to the Health Care environment. Ensures the Business' accountability for compliance… more
- Fallon Health (Worcester, MA)
- …resolve investigations, mitigate risk, and capture results. + 5-8 years of related health care claims auditing experience in a complex healthcare environment, ... and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and...Director of Internal Audit in their leadership of the Fraud , Waste and Abuse (FWA) program. The FWA Manager… more
- CVS Health (Olympia, WA)
- …of your health . This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with ... our ability to innovate and deliver solutions to make health care more personal, convenient and affordable....digital channels. *Controls access to and integrity of CVS Health Fraud Mitigation systems. *Reviews fraud… more
- Olympus Corporation of the Americas (Center Valley, PA)
- …impacting medical devices or similar industries such as the FDA regulations, OIG guidance, health care fraud and abuse, HIPAA, GDPR, and Open Payments. ... advancing medical technologies and elevating the standard of patient care so people everywhere can fulfill their desires, dreams,...to improve patient outcomes by elevating the standard of care in targeted disease states. For more than 100… more
- Guidehouse (New York, NY)
- …7 years of fraud , regulatory compliance, and/orinvestigations experience or relevant health care operations management at any/all of the following: public ... disputes consulting, forensic accounting, operational and/or compliance consulting) or relevant health care operations management at any/all of the following:… more
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