- Dignity Health (Phoenix, AZ)
- …and protection against retaliation. + Respond promptly to reports of potential Medicare fraud , waste, or abuse, (FWA) including coordinating internal ... **Job Summary and Responsibilities** **Job Summary:** The Medicare Compliance Officer (MCO) is responsible for developing, implementing, and overseeing the… more
- Humana (Santa Fe, NM)
- …of our caring community and help us put health first** The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The ... Manager, Fraud and Waste works within specific guidelines and procedures;...+ Minimum of 3 yrs health insurance claims or Medicare experience + Minimum 3 years of experience with… more
- Humana (Oklahoma City, OK)
- …**Required Qualifications** + **Must be an Oklahoma resident** + 2+ years of healthcare fraud investigations and auditing experience + Knowledge of healthcare ... help us put health first** Humana's Special Investigations Unit is seeking a Senior Fraud & Waste Investigator to join the Oklahoma Medicaid Team. This team of… more
- Humana (Albany, NY)
- …healthcare fraud investigations and auditing experience + Knowledge of healthcare payment methodologies + Proven knowledge in Medicare regulations + ... of our caring community and help us put health first** The Senior Fraud and Waste Professional conducts investigations of allegations of fraudulent and abusive… more
- LA Care Health Plan (Los Angeles, CA)
- …or Related Field Experience Required: At least 7 years of experience in healthcare compliance, fraud investigations, law enforcement, or related field. At least ... Preferred And/Or any of the following Licenses/ Certifications: Certified Fraud Examiner (CFE) Certified HealthCare Compliance (CHC) Certified… more
- Molina Healthcare (Covington, KY)
- …insurance company + Minimum of two (2) years' experience working on healthcare fraud related investigations/reviews + Proven investigatory skill; ability to ... data, medical records, and billing data from all types of healthcare providers that bill Medicaid/ Medicare /Marketplace. **KNOWLEDGE/SKILLS/ABILITIES** + Ensure… more
- Community Hospital Corporation (Greenville, TX)
- Hunt Regional Healthcare , a leading independent Hospital District anchored by a 187-bed medical center in Greenville, Texas, is seeking an experienced and strategic ... healthcare executive to assume the role of Chief Financial...performance of managed care contracts. + Administration of all Medicare & Medicaid Reimbursement issues, including the completion and… more
- Prime Healthcare (Dallas, TX)
- Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360 ... nearly 57,000 employees and physicians. Eighteen 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
- GE HealthCare (Boston, MA)
- …provides legal leadership and strategic legal advice related to GE HealthCare research, product development and collaboration activities. Acting as a strategic ... segment and technology teams on legal issues related to GE HealthCare sponsored and investigator-initiated research and collaboration proposals and engagements.… more
- Grant Thornton (Atlanta, GA)
- …for business and IT process optimization, profit improvement, cost reduction, fraud prevention, internal control, and compliance. + Perform engagement management ... 4 years of direct experience with diverse life sciences companies or healthcare providers, including hospitals, academic medical centers, healthcare systems, and… more
- Molina Healthcare (AZ)
- …providers, and advocacy groups. + Conducts peer reviews and supports fraud , waste, and abuse mitigation efforts. **Job Qualifications** **Required Qualifications** + ... utilization management policies across health plans or navigating varied state Medicaid/ Medicare regulations. + Working knowledge of national, state, and local laws;… more
- Aveanna Healthcare (Homestead, FL)
- …per hour Position Details CLINICAL RESEARCH NURSE - Illingworth (RN) Job Overview: Aveanna Healthcare is seeking nurses ie Registered Nurses to act as a key member ... that may be required Report any suspected misconduct or fraud to Aveanna & Illingworth and associated companies Where...have visual and hearing acuity As an employer accepting Medicare and Medicaid funds, employees must comply with all… 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
- Point32Health (Canton, MA)
- …knowledge of government regulations as they relate to the administration of Medicare and/or Medicaid healthcare programs, principles, and practices of managed ... healthcare activities. + Strong subject matter expertise in Medicare and/or Medicaid Operations and Compliance Requirements + Demonstrated effectiveness… more
- Atlantic Health System (Morristown, NJ)
- …(iv) accountable care organization compliance; (v) Medicare C & D/ Medicare Advantage compliance program requirements; (vi) Federal healthcare program ... compliance risk areas: (i) general compliance and compliance program effectiveness; (ii) fraud , waste and abuse and Deficit Reduction Act of 2005 workforce member… more
- University of Rochester (Brighton, NY)
- …assisted living communities. This includes, but is not limited to fraud and abuse, billing compliance, corporate transactions, physician employment and compensation, ... researches, analyzes, and provides regulatory compliance advice on the Fraud and Abuse + Laws, including, but not limited...the False Claims Act, Civil Monetary Penalties, and + Medicare and Medicaid billing regulations (including CMS, Medicare… more
- State of Colorado (Pueblo, CO)
- …for 10 staff members, including direct supervision of 3 individual units: Medicare /Other Insurance, Medicaid/Self- pay, and Audit, including 3 professional staff, 6 ... as they pertain to patient benefits and revenue for the Hospitals, Medicare , Medicaid, and Fiduciary Duties. + Interprets, analyzes, and keeps apprised of… more
- AmeriHealth Caritas (Columbus, OH)
- …An associate's degree, with a minimum of four years of experience working in healthcare fraud , waste, and abuse investigations and audits. + Experience and ... + Bachelor's degree with a minimum of two years of experience in the healthcare field working in fraud , waste, and abuse investigations and audits OR… more
- CVS Health (Columbus, OH)
- …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 ... national in scope, complex cases, or cases involving multiple perpetrators or intricate healthcare fraud schemes. + Investigates to prevent payment of fraudulent… more
- Magellan Health Services (Boise, ID)
- …Certifications - Required License and Certifications - Preferred AHFI - Accredited Healthcare Fraud Investigator - EnterpriseEnterprise, CFE - Certified Fraud ... and prioritize leads from internal and external sources + Use knowledge of healthcare coding conventions, fraud schemes, and general areas of vulnerability,… more