- Molina Healthcare (Cincinnati, OH)
- …Oversees data mining and data analysis to identify outliers/potential fraud , waste, abuse and overpayments within overall payment integrity framework * ... and internal policies and procedures related to detecting, correcting, and preventing fraud , waste and abuse. Responsibilities may include data mining and… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …vulnerabilities indicative of potential underlying operational compliance issues. + Utilizes data analytics techniques, statistical analysis and modeling, and ... highlighted by the OIG, Medicare, State Medicaid, State Insurance Fraud ; Managed Care or Governmental Value-Based payment ...all activities related to recovery and repayment of inappropriate payments discovered as a result of claims audit or… more