- Insight Global (Windsor Mill, MD)
- Job Description A client of Insight Global is looking for a Fraud Waste and Abuse Healthcare Analytics Manager to lead their team of about 10-15 ... in Data Science or related field. Experience in healthcare fraud , waste , and abuse analytics using claims data specifically in Medicare/Medicaid… more
- CVS Health (Annapolis, MD)
- …a team of investigators in our efforts to identify, prevent, and mitigate healthcare fraud , waste and abuse . This role involves not only directing ... and affordable. **Position Summary** Aetna is seeking an experienced Healthcare Fraud Manager to lead and oversee...strong leadership and analytical skills, a deep understanding of healthcare fraud schemes and the ability to… more
- Humana (Annapolis, MD)
- …Waste is responsible for overseeing a wide range of investigations and audits related to waste , abuse , and fraud . This role ensures that all audits comply ... with federal and state Medicaid fraud , waste , and abuse guidelines....CFE (Certified Fraud Examiner) or AHFI (Accredited Healthcare Fraud Investigator) **Additional Information** + Benefits… more
- CVS Health (Annapolis, MD)
- …**Education** + A Bachelors degree or three years of experience in healthcare fraud , waste , and abuse investigations and audits. **Pay Range** The ... of 3 years of experience in healthcare within auditing, compliance, or fraud , waste and abuse . + Knowledge of CPT/HCPCS/ICD coding. + Proficiency in… more
- CareFirst (Columbia, MD)
- …or as lead in part of an assigned team develop and conduct healthcare fraud , waste , and abuse investigations of all levels (low to complex). Develop ... be health care specific and includes independently conducting healthcare fraud , waste , and abuse investigations of all levels. **Knowledge, Skills and… more
- Maryland Department of Transportation (Anne Arundel County, MD)
- …functions. These functions typically include planning, conducting, and finalizing investigations of fraud , waste , and abuse in a timely, effective ... to the following: + Receives and logs allegations about fraud , waste , and abuse and...We offer more than just a paycheck We offer healthcare , dental, long term disability, flexible work schedules, and… more
- Elevance Health (Hanover, MD)
- …errors. Works with health plan leaders, oversees the monitoring and enforcement of the fraud , waste , and abuse compliance program to prevent and detect ... potential fraud , waste , and abuse activities pursuant to state...Requires a BA/BS in business, engineering, nursing, finance, or healthcare administration and minimum of 5 years related work… more
- SMX (Washington, DC)
- …and develops mitigation strategies + ** Fraud Investigation:** Conducts investigations into suspected fraud , waste , and abuse + ** Fraud Awareness and ... Analyzes costs to identify opportunities for savings and efficiencies ** Fraud Prevention and Detection** + ** Fraud Risk...the DoD to highly assured and compliant solutions for healthcare , we understand that digital transformation is key to… more
- Elevance Health (Hanover, MD)
- …and minimum of 6 years medical coding/auditing experience, including minimum of 4 years in fraud , waste abuse experience; or any combination of education and ... and/or entities that may pose potential risk associated with fraud and abuse . **How you will make...next step in the claims lifecycle. + Researches new healthcare related questions as necessary to aid in investigations… more
- Humana (Annapolis, MD)
- …regulatory and operational issues. + Provide guidance related to the application of fraud , waste , and abuse laws, including the Anti-Kickback Statute, ... benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also...our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions… more
- Prime Therapeutics (Annapolis, MD)
- …risk management and increase efficiencies; and reduces the potential for non-compliance, fraud , waste , and abuse . **Responsibilities** + SOC1 Reporting: ... using a variety data analysis techniques. **Preferred Qualifications** + Managed healthcare , health insurance, or other highly regulated industry + Relevant… more