- CVS Health (Annapolis, MD)
- …+ A Bachelors degree or three years of experience in healthcare fraud , waste , and abuse investigations and audits. **Anticipated Weekly Hours** ... of 3 years of experience in healthcare within auditing, compliance, or fraud , waste and abuse . + Knowledge of CPT/HCPCS/ICD coding. + Proficiency in… 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
- CVS Health (Annapolis, MD)
- …with a focus on developing performance measures, managing relationships, and addressing fraud , waste , and abuse within the pharmacy network. ... for pharmacy network contracts. + Identify and flag potential fraud , waste , and abuse within...with cross-functional teams. **Preferred Qualifications:** + Experience in the healthcare or pharmacy industry. + Experience in identifying and… more
- Elevance Health (Hanover, MD)
- …and minimum of 4 years medical coding/auditing experience, including minimum of 1 year 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
- CVS Health (Annapolis, MD)
- …between Aetna, Caremark, and pharmacy partners. + Analyze risk, flags, and trends to mitigate fraud , waste , and abuse within the pharmacy network. + Manage ... are advantageous. + Experience with Medicare. + Experience in identifying and preventing fraud , waste , and abuse in pharmacy services. **Education:** +… more
- Humana (Annapolis, MD)
- …to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud , waste , and abuse to ensure appropriate course of action. ... 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