- 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
- Serco (Herndon, VA)
- …in supporting eligibility processing for individuals seeking access to the Federal Healthcare Insurance Marketplace under the Centers for Medicare and Medicaid ... in Herndon, VA is seeking a highly skilled (10-12 years of experience) **Document Fraud Detection Subject Matter Expert** to join our team. This role is ideal for… more
- Humana (Dayton, OH)
- …**Required Qualifications** + Must reside in Ohio + At least 2 years of healthcare fraud investigations and auditing experience + Knowledge of healthcare ... part of our caring community and help us put health first** This Senior Fraud and Waste Investigator will serve as Humana's Program Integrity Officer, who will… 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
- General Dynamics Information Technology (Fairfax, VA)
- …**Public Trust/Other Required:** None **Job Family:** Ancillary Health **Skills:** Healthcare Fraud (Inactive),Insurance Fraud Investigations,Insurance ... Coding Subject Matter Expert (SME) supporting the Centers for Medicare and Medicaid (CMS), you will be trusted to...and Medicaid (CMS), you will be trusted to research healthcare fraud trends and draft supporting documenting… more
- Molina Healthcare (Ann Arbor, MI)
- …The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses ... oral and written communication skills and presentation skills. + Medicare and Marketplace experience **JOB QUALIFICATIONS** **Required Education** High School… 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
- 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
- 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
- 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
- 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
- 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
- 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
- Excellus BlueCross BlueShield (Rochester, NY)
- …this position is responsible for the accurate and thorough clinical investigation of potential fraud , waste and abuse (FWA) for all lines of business. The scope of ... + Prepares recommendations on preventive/corrective measures for the deterrent of future fraud . + Supports other SIU investigators and analysts with their cases by… more
- AmeriHealth Caritas (Columbia, SC)
- …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 (Richmond, VA)
- …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 ... involving multi-lines of business, or cases involving multiple perpetrators or intricate healthcare fraud schemes. + Investigates to prevent payment of… more
- CVS Health (San Antonio, TX)
- …a team of investigators to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply ... the planning and execution of investigations of acts of healthcare fraud and abuse by both members... Program Integrity, Medicaid Special Investigation or Medicaid / Medicare / Commercial Compliance role Strong verbal and written… more
- Humana (Indianapolis, IN)
- …Dual Eligible Special Needs Plans (DSNP), which serve members who qualify for both Medicare and Medicaid. They will lead the state Medicaid executive team and report ... with federal and state laws and programmatic requirements, including fraud , waste, and abuse; make decisions in an ethical...new ideas and initiatives from across the Medicaid and healthcare industry + Effectively support the growth of associates… more
- Option Care Health (Bannockburn, IL)
- …in Healthcare Compliance (CHC), Certified Internal Auditor (CIA), Certified Fraud Examiner (CFE), or similar certification preferred. + Direct experience in home ... that attracts, hires and retains the best and brightest talent in healthcare . **Job Description Summary:** The Analyst, Compliance Auditing, Monitoring and Analytics… more