- CVS Health (Hartford, CT)
- …more personal, convenient and affordable. **Position Summary** We are seeking an experienced Healthcare Fraud Manager to lead and oversee a team of investigators ... in our efforts to identify, prevent, and mitigate healthcare fraud , waste and abuse. This role...Dental Investigation experience + Broker Investigative experience in the Medicare and the Marketplace + Team management experience. **Education:**… more
- CVS Health (Charleston, WV)
- …you will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high ... involving multi-lines of business, or cases involving multiple perpetrators or intricate healthcare fraud schemes. + Investigates to prevent payment of… more
- Molina Healthcare (Columbus, OH)
- …escalations are achieved. Coordinates with both the Associate Vice President of Fraud , Waste and Abuse (FWA) and Associate Vice President of Special Investigations ... and internal policies and procedures related to detecting, correcting, and preventing fraud , waste and abuse. Responsibilities may include data mining and data… more
- Fallon Health (Worcester, MA)
- …+ Additional certification applicable to this work is a plus, such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or ... to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)-… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …Committee Qualifications: + Bachelor's degree desired + Minimum 5 years of experience in Medicare Advantage Plans or healthcare industry at large + Proven track ... Position Purpose: The Manager - Fraud , Waste & Abuse (FWA) is responsible for...WorkPlan, and related activities + Detect, investigate and report fraud , waste and abuse cases + Lead special investigations,… more
- CACI International (Baltimore, MD)
- Fraud Analyst Job Category: Finance and Accounting Time Type: Part time Minimum Clearance Required to Start: DOJ MBI Employee Type: Regular Percentage of Travel ... of Travel: Local * * * **The Opportunity:** The Fraud Analyst position is a great opportunity for analysts.... + Formulate data runs or inquiries from large Medicare and Medicaid databases to elicit particular billing patterns… more
- Molina Healthcare (Columbus, OH)
- …The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses ... of experience working in a FWA / SIU or Fraud investigations role for New Jersey/New York location +...to health insurance, investigations & legal processes (Commercial insurance, Medicare , Medicare Advantage, Medicare Part… more
- Molina Healthcare (Columbus, OH)
- …reporting, and when appropriate, recovery of money related to health care fraud , waste, and abuse. Duties include performing accurate and reliable medical review ... Counsel, and Medical Affairs, in order to achieve and maintain appropriate anti- fraud oversight. **Job Duties** * Perform objective desk and onsite medical record… more
- Hartford HealthCare (Hartford, CT)
- Work where*every moment*matters. Every day, over 30,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every ... here. We invite you to become part of Connecticut's most comprehensive healthcare network. Hartford HealthCare 's unified culture enhances access, affordability,… more
- Molina Healthcare (AZ)
- …reporting, and when appropriate, recovery of money related to health care fraud , waste, and abuse. Duties include performing accurate and reliable medical review ... Counsel, and Medical Affairs, in order to achieve and maintain appropriate anti- fraud oversight. **Job Duties** * Perform objective desk and onsite medical record… more
- KPH Healthcare Services, Inc. (Lehighton, PA)
- …services to more than 50,000 residents. HealthDirect is a division of KPH Healthcare Services, a billion dollar, 100% employee owned provider of pharmaceutical and ... healthcare services. KPH is comprised of four divisions -...related field **Experience:** + Preferred: 1 to 2 years Medicare billing + Preferred: General knowledge of Medicare… more
- Prime Healthcare (Ontario, CA)
- Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 ... nearly 50,000 employees and physicians. Fourteen of the Prime Healthcare hospitals are members of the Prime Healthcare...the Antikickback Statute, the False Claims Act, and other Fraud , Waste and Abuse laws and regulations, along with… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …to 2 years Long Term Care pharmacy billing + Preferred: General knowledge of Medicare D Insurance, Medicare A, Accounting, Third Party Processing and/or Pharmacy ... + HIPAA Privacy Course + HIPAA Security Course + Fraud , Waste, and Abuse Course + MethGuard Course **Behavioral...as relevant skills, years of experience and education. KPH Healthcare Services, Inc. is a multistate organization and abides… 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 ... services and eligibility of providers as requested. + Assists prosecutors in Healthcare Fraud investigations by reviewing provider and patient records. +… more
- CVS Health (Hartford, CT)
- …You will lead a team responsible for ensuring the quality and integrity of healthcare fraud and abuse investigations. This role involves overseeing the training ... You will lead a team responsible for ensuring the quality and integrity of healthcare fraud and abuse investigations. This role involves overseeing the training… more
- KPH Healthcare Services, Inc. (Oklahoma City, OK)
- …plans and any changes that possibly may occur within the Insurance Payor, Medicare , or Medicaid + Responsible for completing all mandatory and regulatory training ... the specific position **Required Training:** + HIPPA Privacy & Security Course + Fraud , Waste, and Abuse Course **Job Skills Required:** + Exceptional attention to… more
- CVS Health (Trenton, NJ)
- …from home anywhere in the United States. We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU). ... role, you will manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct high… 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 ... for the development of compliance internal monitors and audit protocols and the prevention of fraud , waste and abuse. + Develops compliance monitors and audit… more
- Humana (Columbus, OH)
- …us** About CarePlus Health Plans: CarePlus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in ... policies, procedures, and regulations and to prevent and detect fraud , waste, and abuse. The RN Compliance Nurse 2,...denial letters prior to mailing to ensure compliance with Medicare requirements + Analyze authorizations and medical records in… more
- CVS Health (Albany, NY)
- …Summary** Serves as the single point of contact for State Medicaid, Medicare programs for all program integrity related issues. This includes regulatory reporting, ... coordinating interdepartmental program integrity initiatives, vendor oversight of fraud waste and abuse (FWA) activity, and identifying services at risk for FWA. You… more