- 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
- Elevance Health (Chicago, IL)
- ** Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 ... is determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Fraud Investigator II** is responsible for identifying… more
- Humana (Indianapolis, IN)
- …reside in Indiana or a state bordering Indiana. + At least 2 years of healthcare fraud investigations and auditing experience + Knowledge of healthcare ... community and help us put health first** This Senior Fraud and Waste Investigator will serve as...degree + Graduate degree and/or certifications (MBA, JD, MSN, Clinical Certifications, CPC, CCS, CFE, AHFI) + Understanding of… more
- State of Massachusetts (Boston, MA)
- … II, and INVESTIGATOR III ** ** HEALTHCARE &FAIRCOMPETITIONBUREAU MEDICAID FRAUD DIVISION AttorneyGeneralAndrea Joy Campbell ... isseekinghighlymotivatedcandidatestojoinherteamintheroleof Investigator in the Medicaid Fraud Division.We are currently seeking candidates with a range 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
- CVS Health (WV)
- … 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 ... of business, or cases involving multiple perpetrators or intricate healthcare fraud schemes. + Investigates to prevent...lines of business + Researches and prepares cases for clinical and legal review + Documents all appropriate case… more
- State of Georgia (Fulton County, GA)
- …Georgia Medicaid Program. Participates as a member of an interdisciplinary team in Healthcare fraud investigations, and provides support to members of other ... of the Attorney General Georgia Department of Law Nurse Investigator - Medicaid Fraud Division *To move forward...eligibility of providers as requested. + Assists prosecutors in Healthcare Fraud investigations by reviewing provider and… more
- CVS Health (CT)
- …investigations to effectively pursue the prevention, detection, investigation and prosecution of healthcare fraud , waste, and abuse. Also reports suspected ... **Fundamental Components:** - Conducts investigations of known or suspected acts of healthcare fraud , waste, and abuse - Communicates with federal, state,… more
- Providence (Oakland, CA)
- …data mining software/tools. **Preferred Qualifications:** + Current certification as an Accredited Healthcare Fraud Investigator (AHFI) upon hire. + ... providing education related to coding, medical record documentation requirements, healthcare compliance and fraud , waste and abuse...Certification as an Internal Auditor or Healthcare Compliance certification upon hire. + Clinical … more
- CVS Health (OK)
- …- Conducts investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply ... - Conducts investigations of known or suspected acts of healthcare fraud and abuse. - Communicates with... and abuse. - Researches and prepares cases for clinical and legal review. - Documents all appropriate case… more