- State of Minnesota (St. Paul, MN)
- **Working Title: Medicaid Provider Audits and Investigations Manager** **Job Class: Human Services Manager 2** **Agency: Human Services Dept** + **Job ... The incumbent manages anti-fraud, waste, and abuse efforts, including provider investigations , prevention, education, and enforcement activities.… more
- Humana (Tallahassee, FL)
- …and documentation to support successful adjudication, where appropriate. Conducts on-site audits of provider records ensuring appropriateness of billing ... help us put health first** The Senior Fraud and Waste Professional conducts investigations of allegations of fraudulent and abusive practices. The Senior Fraud and… more
- Commonwealth Care Alliance (Boston, MA)
- …regulations, and CMS payment methodologies (eg, DRG, APC, RBRVS). + Support provider appeal reviews and internal payment integrity investigations by providing ... post-payment audits . + Assist in the resolution of complex provider disputes and escalations, including direct support to leadership in pricing determinations… more
- CVS Health (San Antonio, TX)
- …accreditation from the National Health Care Anti-Fraud Association (AHFI) * Experience In Medicaid Compliance, Medicaid Investigations , TX MCO Medicaid ... and Fraud, Waste and Abuse activities related to TX Medicaid and CHIP programs. Oversees activities related to the...5+ years of managing healthcare fraud, waste and abuse investigations and audits . 3+ years of leadership… more
- NTT America, Inc. (Little Rock, AR)
- …adaptable, and forward-thinking organization, apply now. We are currently seeking a Medicaid Privacy Auditor to join our team in Little Rock, Arkansas (US-AR), ... with the DHS Privacy Officer, will be a key contributor in conducting audits and other services for the DHS Privacy Office. These services include: conducting… more
- LA Care Health Plan (Los Angeles, CA)
- Director, Compliance on Special Investigations Unit and Fraud, Waste and Abuse Job Category: Administrative, HR, Business Professionals Department: Special ... Investigations Unit Location: Los Angeles, CA, US, 90017 Position...public agency created by the state of California to provide health coverage to low-income Los Angeles County residents.… more
- State of Georgia (Fulton County, GA)
- …the Attorney General. The position filled through this announcement will serve within the Audits section of the Medicaid Fraud Division. Job Summary Under the ... direction of the Fraud Unit Director, assists in healthcare investigations by: reviewing provider and recipient records, by making determinations of medical… more
- MyFlorida (Tallahassee, FL)
- …Bureau of Medicaid Program Integrity (MPI) does this specifically through audits and investigations of healthcare providers, including managed care plans. ... efficient, effective research, analysis, reviews, investigations , and audits , to determine violations of Medicaid policies,...be made in advance to allow sufficient time to provide the accommodation. The State of Florida supports a… more
- AmeriHealth Caritas (Columbus, OH)
- …two years of experience in the healthcare field working in fraud, waste, and abuse investigations and audits OR + An associate's degree, with a minimum of four ... years of experience working in healthcare fraud, waste, and abuse investigations and audits . + Experience and training/certifications commensurate with position… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …include: A minimum of five years in the healthcare field working in FWA investigations and audits ; or five years of insurance claims investigation experience or ... include substantiating referrals, case planning and research, conducting onsite or desk audits , clinical reviews of medical records to ensure correct billing of… more
- State of Minnesota (St. Paul, MN)
- … Medicaid misbilling, overpayments, and fraud -Principles and practices of provider audits , program integrity initiatives, health care delivery systems, ... The Department of Human Services (DHS) is unable to provide sponsorship for work visas. Applicants must be eligible...the scope of the RAC, UPIC, and other contractor audits ._ + _Serve as liaison on contractor matters with… more
- CVS Health (Charleston, WV)
- …accreditation from the National Health Care Anti-Fraud Association (AHFI) + Experience In Medicaid Compliance, Medicaid Investigations , MCO Medicaid FWA ... comply with state regulations mandating fraud plans and reporting; Medicaid experience is preferred. Leads a team in the...5 years of managing healthcare fraud, waste and abuse investigations and audits . + 3 to 5… more
- Molina Healthcare (Louisville, KY)
- …emphasis on fraud investigations . + Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. + Understanding of claim billing ... fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. The SIU Investigator… more
- Johns Hopkins University (Baltimore, MD)
- …evaluation programs. + Perform project evaluations on assigned internal audit staff. Provide input to Executive Director Operational Audits and Associate ... to understand the impact on your own work. + Provide detailed progress updates of audits , including...develop new audit tools and techniques. + Conduct specialized audits , projects or investigations requested by Institutional… more
- MVP Health Care (Rochester, NY)
- …compliance initiatives or policies. + Minimal travel may be required pertaining to investigations and audits . + Contribute to our humble pursuit of excellence ... for you if you have a passion for problem solving and investigations , commitment to compliance and ethical standards and dedication to continuous learning… more
- State of Minnesota (St. Paul, MN)
- …: Yes The Department of Human Services (DHS) is unable to provide sponsorship for work visas. Applicants must be eligible to work in ... include but are not limited to: + DirectandmanagethescopeoftheRAC, UPIC,andothercontractor audits . + Actasliaisononcontractormatterswithproviders,providerassociations,other Department of Human Services (DHS) divisions… more
- Covenant Health Inc. (Knoxville, TN)
- …include E/M, procedure, and ICD-10 reviews, as well as any needed provider or staff education. Also provides consulting services to the organization's management ... and staff and may participate in requested investigations . Maintains all organizational and professional ethical standards. Works independently under limited… more
- CVS Health (Oklahoma City, OK)
- …in Oklahoma. - 1+ years experience working in healthcare fraud, waste and abuse investigations and audits . - Experience reviewing and analyzing claims data to ... with different groups of people at different levels and provide assistance on a timely basis. - Proficiency in...years working in health care fraud, waste, and abuse investigations and audits . **Anticipated Weekly Hours** 40… more
- Novant Health (Charlotte, NC)
- …improvement, health information management, release of information, charge capture, coding audits , provider education, and charge master optimization. This role ... alignment with federal/state regulations.Auditing and InvestigationConducts regular and frequent audits and investigations to identify and correct errors… more
- SSM Health (Waupun, WI)
- …develop, implement and monitor action plans for any identified non-compliance. + Conducts investigations and audits to identify areas of risk. Drafts plans for ... knowledge of all The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS) Conditions of Participation and State Hospital Licensing Act standards… more