- Sanford Health (Fargo, ND)
- …Health Care Fraud Investigator (AHFI) certification or Certified Fraud Examiner (CFE) preferred Nursing or other clinical experience highly preferred ... health insurance investigation/audit. - Master's Degree preferred - Accredited Health Care Fraud Investigator (AHFI) certification or Certified Fraud … more
- Blue KC (Kansas City, MO)
- …Description Summary:** As part of Blue KC's Special Investigations Unit (SIU), the Fraud Investigator conducts reviews to identify potential fraud , waste, ... AHIMA + FWA Certification: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI) + Medical License: Registered Nurse (RN), Licensed… more
- Humana (Oklahoma City, OK)
- …and 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 ... Humana's Oklahoma Medicaid line of business. As the Senior Fraud and Waste Investigator , you will serve...+ Bachelor's degree or higher + Any applicable certifications ( Clinical Certifications, CPC, CCS, CFE, AHFI) + Understanding of… more
- Humana (Carson City, NV)
- …of our caring community and help us put health first** The Senior Fraud and Waste Professional (Program Integrity Lead) is responsible for overseeing the monitoring ... and enforcement of the Fraud , Waste, and Abuse (FWA) program. This role aims...(preferred, not required)Graduate degree and/or certifications (MBA, JD, MSN, Clinical Certifications, CPC, CCS, CFE, AHFI). + Understanding of… more
- MVP Health Care (Rochester, NY)
- …innovative thinking and continuous improvement. To achieve this, we're looking for a ** Clinical Investigator ** to join #TeamMVP. This is the opportunity for you ... professional investigation experience involving economic or insurance related matters. + A clinical investigator must have in addition to the above requirements:… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …of the SIU Management, this position is responsible for the accurate and thorough clinical investigation of potential fraud , waste and abuse (FWA) for all lines ... substantiating referrals, case planning and research, conducting onsite or desk audits, clinical reviews of medical records to ensure correct billing of services and… more
- AmeriHealth Caritas (Columbus, OH)
- …services. Discover more about us at www.amerihealthcaritas.com. The Investigator is responsible for conducting comprehensive investigations of reported, ... alleged or suspected fraud involving the full range of products at the...lieu of formal educational requirements for the Lead SIU Investigator position may be considered.; + Valid driver's license… more
- CVS Health (Nashville, TN)
- …every day. **Position Summary** **WEST VIRGINIA RESIDENCY** **REQUIRED** As a Senior Investigator you will conduct high level, complex investigations of known or ... suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive...lines of business + Researches and prepares cases for clinical and legal review + Documents all appropriate case… more
- State of Georgia (Fulton County, GA)
- …Job Alerts The Office of the Attorney General Georgia Department of Law Nurse Investigator - Medicaid Fraud Division *To move forward in the recruiting process ... Nurse Investigator Georgia - Fulton - Atlanta (https://ga.referrals.selectminds.com/jobs/64040/other-jobs-matching/location-only) Hot...will serve within the Audits section of the Medicaid Fraud Division. Job Summary Under the direction of the… more
- Point32Health (Canton, MA)
- …about who we are at Point32Health (https://www.point32health.org/) . **Job Summary** The Investigator I is an essential team member of the Special Investigation Unit ... ("SIU") responsible for leading complex provider investigations related to fraud , waste, and abuse, and developing action plans to...the direction of the Manager, FWA Prepayment Review. The Investigator I works closely with other members of the… more
- Centene Corporation (Tallahassee, FL)
- …future fraudulent and erroneous practices + Consult investigators to identify abuse and fraud by utilizing clinical and coding expertise to analyze patterns in ... reviews of medical records to identify potential abuse and fraud and inappropriate billing practices + Investigate, analyze, and...OT or ST license and 2+ years of related clinical experience in the field of obtained license. Experience… more
- Providence (Oakland, CA)
- …software/tools. **Preferred Qualifications:** + Current certification as an Accredited Healthcare Fraud Investigator (AHFI) upon hire. + Certification as an ... **Description** ** Investigator External Audit Special Investigations Unit \*Remote The...to coding, medical record documentation requirements, healthcare compliance and fraud , waste and abuse to Health Plan staff, vendors… more
- Lane County (OR)
- Investigator Print (https://www.governmentjobs.com/careers/lanecountyor/jobs/newprint/5128761) Apply Investigator Salary $85,176.00 - $116,584.00 Annually ... an integral member of our public safety team, this Investigator role will primarily support the Family Law (Child...thorough investigations in areas such as public corruption, major fraud , missing persons, or estate and child support enforcement.… more
- Molina Healthcare (Milwaukee, WI)
- **JOB DESCRIPTION** **Job Summary** The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical ... records to document relevant findings of a post pay clinical review. This position manages documents and prioritizes case...of experience working in a FWA / SIU or Fraud investigations + Thorough knowledge of PC based software… more
- CVS Health (Oklahoma City, OK)
- …investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with state ... regulations mandating fraud plans and practices. - Conducts investigations of known... and abuse. - Researches and prepares cases for clinical and legal review. - Documents all appropriate case… more
- Bausch + Lomb (Sacramento, CA)
- …future. **Objective:** Under the supervision of the Director or designee of Clinical Operations, responsible for overseeing the implementation of clinical ... conducted according to the Investigational Plan and all applicable regulations. Provide clinical and technical expertise for Clinical Programs and Marketing… more
- General Dynamics Information Technology (Fairfax, VA)
- …Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) designation strongly desired. + Certified clinical coding **SOFT SKILLS ... **Skills:** Claims Data,Data Analysis,Microsoft Excel,Policy Analysis,Strategic Objectives **Certifications:** Certified Fraud Examiner (CFE) | Association of Certified Fraud… more
- Astellas Pharma (Northbrook, IL)
- …services, advisory boards and councils, data sharing and data licensing, investigator -initiated studies, regulatory and quality agreements + Providing legal and ... complex agreements in support of Development, including agreements for clinical trials, assay development, companion diagnostics, expanded access, compassionate use,… more
- Parsons Corporation (San Antonio, TX)
- …for assisting with the collection of supporting documentation, coordinating clinical research studies, and maintaining regulatory requirements. In addition, the ... IACUC/IRB requirements. + Develop and coordinate the implementation of clinical research studies, including regulatory requirements, maintenance of study records,… more