- Guidehouse (New York, NY)
- …guide clients through the selection, implementation, testing, and calibration/tuning of healthcare fraud technology solutions for Life Sciences companies, Public ... intent to assist with designing processes to define characteristics of different fraud typologies relevant to healthcare and collaborate with cross-functional… more
- University of Texas Rio Grande Valley (Mcallen, TX)
- …obtain background information. + Identifies risk and related controls, including potential healthcare fraud risks during planning and fieldwork. + Develops ... Scope of Job Participates in the planning, performance, and follow-up of routine healthcare related audits and consulting engagements for the UTRGV healthcare … more
- MyFlorida (Miami, FL)
- …or education requirements of s. 943.135. Preference will be given to candidates with healthcare fraud investigative experience working in a Medicaid Fraud ... enforcement experience, or five (5) years of work experience conducting healthcare fraud investigations. Note: All newly hired employees must obtain CJSTC Sworn… more
- CVS Health (Richmond, VA)
- …- Conducts investigations to effectively pursue the prevention, investigation, and prosecution of healthcare fraud and abuse, to recover lost funds, and to ... and practices. - Conducts investigations of known or suspected acts of healthcare fraud and abuse. - Communicates with federal, state, and local law enforcement… more
- MyFlorida (Tallahassee, FL)
- …with a program integrity related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator; Certified ... is to ensure fewer budgeted dollars are lost to fraud , abuse, and waste. The Bureau of Medicaid Program...(MPI) does this specifically through audits and investigations of healthcare providers, including managed care plans, suspected of engaging… more
- New York State Civil Service (Hauppauge, NY)
- …the Unit's forensic accountants/auditors, detectives, and analysts to identify and prosecute financial fraud in the healthcare industry and abuse and neglect of ... General, Office of the Title Associate Attorney: Investigate/Prosecute Medicaid Fraud (3696) Occupational Category Legal Salary Grade NS Bargaining...residents in healthcare facilities, present evidence to grand juries, and conduct… more
- CVS Health (Hartford, CT)
- …investigations to effectively pursue the prevention, detection, investigation and prosecution of healthcare fraud , waste, and abuse. Also reports suspected ... Fundamental Components: - Conducts investigations of known or suspected acts of healthcare fraud , waste, and abuse - Communicates with federal, state, and local… more
- MyFlorida (Miami, FL)
- …with a program integrity related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator; Certified ... and an understanding about legal proceedings and investigations related to health care fraud and abuse. The Florida Medicaid program is one of the five largest… more
- Providence (OR)
- …certification in health care fraud investigation, such as Accredited Healthcare Fraud Investigator (AHFI), Certification as an Internal Auditor (CIA), ... behavior change + Provide education related to coding, medical record documentation requirements, healthcare compliance and fraud , waste and abuse to Health Plan… more
- CVS Health (Hartford, CT)
- …a team of investigators to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply ... a team in the planning and execution of investigations of acts of healthcare fraud and abuse by both members and providers.- Provides direction and counsel on… 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 ... and eligibility of providers as requested. + Assists prosecutors in Healthcare Fraud investigations by reviewing provider and patient records. + Makes… more
- DCCA (Columbia, MD)
- …leadership experience . Payment Integrity knowledge and skills . Experience with healthcare fraud analytics . Demonstrates strong communication skills Desired ... Skills : . Healthcare Fraud Programs . Special Investigations Unit (SIU) experience Education/Certifications: . Bachelor's Degree . Accredited Health Care … more
- BlueCross BlueShield of North Carolina (NC)
- …Part D experience preferred. + Experience in identifying and mitigating pharmacy or healthcare fraud , waste, and abuse. + Strong analytical and problem-solving ... , waste, and abuse. This initiative demands expertise in fraud detection and prevention within healthcare or...expertise in fraud detection and prevention within healthcare or pharmacy settings. **What You'll Do** + Manage/administer… more
- Commonwealth Care Alliance (Boston, MA)
- …review, witness interviews and data analysis to identify, evaluate and measure potential healthcare fraud and abuse to determine valid cases for appropriate ... Investigator works with a growing team conducting and managing Health Care Fraud , Waste and Abuse investigation and prevention activities under the general direction… more
- Daiichi Sankyo Inc. (Basking Ridge, NJ)
- …knowledge of laws and regulations applicable to global pharmaceutical companies, including, US healthcare fraud and abuse laws, anti-corruption laws, such as the ... Practices Act and the UK Bribery Act (2010), US fraud and abuse and false claims laws, and relevant...claims laws, and relevant industry codes on interactions with healthcare professionals required - 1 or More Years Prior… more
- Elevance Health (West Des Moines, IA)
- …for the identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds ... pharmacy claims. + Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company health plan,… more
- SAIC (VA)
- …rules and regulations regarding medical coding, reimbursement guidelines, and healthcare fraud ; commercial reimbursement guidelines and policies; coding ... Diseases, Clinical Modification (ICD-CM), and Procedural Coding System (PCS); Healthcare Common Procedure Coding System (HCPCS); and Current Procedural Terminology… more
- Elevance Health (St. Louis, MO)
- …for the identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds ... pharmacy claims. + Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company health plan,… more
- Elevance Health (Richmond, VA)
- …independent identification, investigation and development of complex cases against perpetrators of healthcare fraud in order to recover corporate and client ... claims. + Responsible for independently identifying and developing enterprise-wide specific healthcare investigations and initiatives that may impact more than one… more
- Sanofi Group (Cambridge, MA)
- …counsel on matters relevant to the pharmaceutical industry, including compliance with Healthcare Fraud and Abuse matters, FDA regulations governing the ... Care** **Location: Cambridge, MA** **About the Job:** We are an innovative global healthcare company with one purpose: to chase the miracles of science to improve… more
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