- Humana (Frankfort, KY)
- …a part of our caring community and help us put health first** The Fraud and Waste Professional 2 is responsible for conducting comprehensive investigations of ... reported, alleged or suspected fraud involving Florida's Medicaid Program. The Fraud and Waste Professional 2 coordinates investigation with law enforcement… more
- Molina Healthcare (Lexington, KY)
- …ASSOCIATION** : + Health Care Anti- Fraud Associate (HCAFA). + Accredited Health Care Fraud Investigator (AHFI). + Certified Fraud Examiner (CFE). To all ... investigation, reporting, and when appropriate, recovery of money related to health care fraud , waste , and abuse. Duties include performing accurate and reliable… more
- CVS Health (Frankfort, KY)
- …the United States. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU), ... manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct high level, complex… more
- Molina Healthcare (Lexington, KY)
- …delivery systems + Understanding of datamining and use of data analytics to detect fraud , waste , and abuse + Proven ability to research and interpret regulatory ... position must have the ability to determine correct coding, documentation, potential fraud , abuse, and over utilization by providers and recipients. The position… more
- Molina Healthcare (Lexington, KY)
- …Required License, Certification, Association + Active and unrestricted Accredited Health Care Fraud Investigator (AHFI) designation or Certified Fraud ... + Works with leadership to maintain and revise policies and procedures, fraud , waste , and abuse plans, annual audit work plans, including department guidance… more