- Insight Global (San Antonio, TX)
- …extensive experience in medical coding (CPT codes, ICD-10 codes). . Proven experience in fraud investigation within the health claims sector. . Knowledge of ... claims reserves. As a Mid-Level Life SIU Investigator for Medicare Supplement Fraud , Waste, and Abuse you...Waste, and Abuse you will support the Life Special Investigations team that is responsible for increasing fraud… more
- Humana (Indianapolis, IN)
- …**Required Qualifications** + Bachelor's degree + At least 2 years of healthcare fraud investigations and auditing experience + Knowledge of healthcare payment ... part of our caring community and help us put health first** This Senior Fraud and Waste Investigator will serve as Humana's Program Integrity Officer, who will… more
- Fallon Health (Worcester, MA)
- …the healthcare industry. **Experience:** + Advanced knowledge of FWA operations, fraud investigation and/or detection and analysis, and laws/regulations related ... clinical background. + Strong attention to detail with the ability to identify fraud , assess the impact, resolve investigations , mitigate risk, and capture… more
- State of Georgia (Fulton County, GA)
- …plan the financial and audit strategy for criminal and civil fraud investigations . + Participates in meetings throughout an investigation to discuss various ... Investigative Auditor - Medicaid Fraud Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/64128/other-jobs-matching/location-only) Hot… more
- CVS Health (Tallahassee, FL)
- …and affordable. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU). ... investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct...federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud . +… more
- Molina Healthcare (Columbus, OH)
- …**Required Experience** * Minimum of 8-10 years relevant experience in special investigation units, Insurance Fraud and Abuse, Payment Integrity Program, Law ... **Knowledge/Skills/Abilities** Acts as liaison between Special Investigations Unit (SIU) operations and contracted vendor(s) to assure a smooth workflow exists,… more
- CACI International (Baltimore, MD)
- …their career path supporting the Department of Justice on large and complex fraud investigations . You will gain invaluable experience working with federal ... Fraud Analyst Job Category: Finance and Accounting Time.... + Formulate data runs or inquiries from large Medicare and Medicaid databases to elicit particular billing patterns… more
- Centene Corporation (Austin, TX)
- …Overseeing the development and implementation of Corrective Action Plans + Coordinating potential fraud investigations and referrals from and with the SIU, where ... and employees to report, without fear of retaliation, good faith concerns regarding Medicare non-compliance and potential instances of fraud , waste and abuse… more
- Library of Congress (Washington, DC)
- …(CRS), Domestic Social Policy (DSP) Division seeks an Analyst in Health Policy ( Medicare ) to provide expertise on Medicare (eg, Part B premiums, financing, ... end stage renal disease, fraud , waste and abuse), and federal policies and procedures....ideal candidate will have academic and professional skills/training in Medicare and public health policy (eg, Part B premiums,… more
- Amentum (Pikesville, MD)
- …to identify anomalies that might be indicative of improper billing or other types of fraud . + Formulate data runs or inquiries from large Medicare and Medicaid ... extent necessary to make sound decisions on direction and scope of investigation . Determine proof required to assist in affixing legal responsibility for litigation,… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …and report fraud , waste and abuse cases + Lead special investigations , maintain FWA records, submit to I-MEDIC + Partner with the Internal Audit/Recoveries ... Position Purpose: The Manager - Fraud , Waste & Abuse (FWA) is responsible for...degree desired + Minimum 5 years of experience in Medicare Advantage Plans or healthcare industry at large +… more
- VNS Health (Manhattan, NY)
- …with Compliance and Special Investigation Unit on issues related to Fraud , Waste, and Abuse of Medicare /Medicaid services.* Collaborates with pharmacy ... implementation of new government program policies and the monitoring for fraud , waste, abuse of drugs. Educates pharmacists on adherence, inappropriate prescribing… more
- CVS Health (Annapolis, MD)
- …high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high profile, those ... federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud and...or equivalent experience (3-5 years of working health care fraud , waste and abuse investigations ). **Pay Range**… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …protocols specific to hospital revenue cycle risk areas highlighted by the OIG, Medicare , State Medicaid, State Insurance Fraud ; Managed Care or Governmental ... revenue cycle risk areas + Assists in auditing and investigations requested by the System Director, Compliance. + Assists...payments discovered as a result of claims audit or investigation . + Maintains awareness of fraud , waste… more
- CVS Health (Albany, NY)
- …education may substitute) + Experience in a Healthcare Program Integrity, Medicaid Special Investigation or Medicaid / Medicare / Commercial Compliance role + ... Summary** Serves as the single point of contact for State Medicaid, Medicare programs for all program integrity related issues. This includes regulatory reporting,… more
- AmeriHealth Caritas (Columbia, SC)
- …Ensures compliance with all requirements related to Special Investigation Units and fraud , waste and abuse investigations . + Conducts investigations of ... us at www.amerihealthcaritas.com. The Investigator is responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving… more
- CVS Health (Hartford, CT)
- …will lead a team responsible for ensuring the quality and integrity of healthcare fraud and abuse investigations . This role involves overseeing the training and ... responsible for ensuring the quality and integrity of healthcare fraud and abuse investigations . This role involves...team of Quality Reviewers to effectively assess the prevention, investigation , and prosecution of healthcare fraud and… more
- State of Georgia (Fulton County, GA)
- …Medicaid Program. Participates as a member of an interdisciplinary team in Healthcare fraud investigations , and provides support to members of other disciplines ... of providers as requested. + Assists prosecutors in Healthcare Fraud investigations by reviewing provider and patient...claims and/or claims data; experience in the detection and investigation of healthcare fraud . Additional Information +… more
- CVS Health (Frankfort, KY)
- …and affordable. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator (Pharmacy) to join our Special Investigations Unit. In ... investigations into suspected and known acts of Healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conducts...federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud . +… more
- Molina Healthcare (Columbus, OH)
- …Healthcare Services, Member Services, Claims) to gather documentation pertinent to investigations . * Detect potential health care fraud , waste, and ... **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit (SIU) Investigator is responsible for supporting...when appropriate, recovery of money related to health care fraud , waste, and abuse. Duties include performing accurate and… more