- Elevance Health (Las Vegas, NV)
- …you a check, or ask you for payment as part of consideration for employment. ** Clinical Fraud Investigator II** + Job Family: FRD > Investigation + Type: Full ... evaluation of the collected data. + Performs in-depth investigations on identified providers as warranted. + Examines claims...experience, including minimum of 1 year experience in a Clinical Fraud and Abuse Investigation area; or… more
- Olympus Corporation of the Americas (Center Valley, PA)
- …of experience in investigations , internal control monitoring and testing, or fraud investigations is required. + Other Considerations: Must be willing to ... Description** The Sr. Specialist, Governance, Risk, and Compliance (GRC) Compliance Internal Investigations will play a pivotal role in upholding Olympus' core value… more
- Public Consulting Group (Council Bluffs, IA)
- …. **Responsibilities** + Responsible for managing the day-to-day audit and investigations of Fee-for-Service and Managed Care Oversight audits. The manager ... Agency with its collaboration with CMS Program Integrity Contractor's audits and investigations efforts. This role is responsible to coordinate and make appropriate… more
- MD Anderson Cancer Center (Houston, TX)
- …Cancer Institute. The ideal candidate will have experience with research compliance investigations , good clinical practices investigations , and grant ... experience in a healthcare, academic medical center or related field conducting internal investigations of alleged fraud , waste, and abuse activities as an… more
- Bausch Health (Bridgewater, NJ)
- …requirements and company standard operating procedures (SOPs) during all company clinical investigations and post-market studies + Communicates with vendors ... + Leads or collaborates on required tasks prior to commencement of senior clinical trials that include, but are not limited to: clinical planning,… more
- Elevance Health (Columbus, OH)
- …send you a check, or ask you for payment as part of consideration for employment. ** Clinical Provider Auditor II** + Job Family: FRD > Audit + Type: Full time + Date ... + North Carolina, Winston + District of Columbia, Washington **Description** ** Clinical Provider Auditor II** **Supports the Payment Integrity line of business**… more
- Bausch + Lomb (Rochester, NY)
- …regulatory requirements and company standard operating procedures (SOPs) during all clinical investigations and post-market studies. + Supports CTM/Sr. CTM ... Under the supervision of the Director, Clinical Operations / Sr. Clinical Trial Manager , responsible for supporting the implementation, conduct and closeout… more
- Arkansas Government Job (Little Rock, AR)
- … fraud cases and make determinations based on criteria relevant to fraud investigations . Apply clinical knowledge and experience by interpreting ... facilities. The analyst may also work with prosecutors of the Medicaid Fraud Control Unit (MFCU) on nursing-related issues. Essential job functions include: Review… more
- Corewell Health (Grand Rapids, MI)
- …agencies performing audits as necessary, under the direction of CCO, director, and/or manager . From time to time, performs investigations at the direction of ... standard work opportunities. Leads more complex compliance audits and investigations , ensuring complete resolution. Supports the management of compliance standards,… more
- Sutter Health (Sacramento, CA)
- …Coder OR CRC-Certified Risk Adjustment Coder OR CCDS-Certified Clinical Documentation Specialist OR CIC-Certified Inpatient Coder **TYPICAL EXPERIENCE:** ... compliance program, including auditing, training, monitoring, conducting and documenting investigations , addressing violations and monitoring corrective actions. * Familiarity… more
- Access Dubuque (Dubuque, IA)
- …Improvement _Specialist_ This position is responsible for performing patient safety investigations across UPH-Dubuque as well as patient safety event data analysis ... a great place to work. https://dayinthelife.unitypoint.org/ **Responsibilities** **Patient Safety: Clinical Event Identification & Investigation** + Reviews daily RL… more
- Public Consulting Group (Council Bluffs, IA)
- …Experience: + Previous work experience performing medical records reviews and/or healthcare and fraud investigations . + 2-5 years of experience as a utilization ... achieve team goals. + Assists in reviewing a provider's clinical documentation, as well as participating in and producing...review manager conducting, directing, or leading medical necessity reviews of… more
- Beth Israel Lahey Health (Burlington, MA)
- …14. Participates in complex projects related to denial initiatives and complex investigations into allegations of billing fraud or abuse, as necessary. ... Day (United States of America) Under the managerial oversight of the Senior Manager , the Revenue Performance Analyst serves as a primary point of contact for… more
- Beth Israel Lahey Health (Burlington, MA)
- …9. Participates in complex projects related to denial initiatives and complex investigations into allegations of billing fraud or abuse, as necessary. ... Day (United States of America) Under the managerial oversight of the Director, Senior Manager , or Manager of Revenue Cycle, the Revenue Cycle Analyst serves as… more
- Bausch Health (Bridgewater, NJ)
- …and ensures adherence to CGMP compliance in a regulated environment. Support the Manager of R&D Quality who is responsible for the effective management of the ... qualifications and equipment calibration). + Review and approve deviation and OOS investigations . + Review and approved method transfers. + Facilitate GMP product… more
- Covenant Health Inc. (Knoxville, TN)
- …to the organization's management and staff and may coordinate requested coding investigations . Responsible for education and training for all Covenant coders, CDI, ... initiative and independent judgment. Reports to the Corporate Coding Manager or CFO of CMG as appropriate. Recruiter: Sarah...by CMS and the OIG via the Federal Register, fraud alerts, OIG advisory opinions, and other publications relative… more
- City of New York (New York, NY)
- …Offer any recommended referrals for ancillary services, as needed. - Accompany Fraud Investigators conducting eligibility investigations to assess health and ... Oversee any other tasks, as assigned by the Path Manager . Qualifications Qualification Requirements A Master's Degree in Social...a valid Licensed Master Social Worker (LMSW) or Licensed Clinical Social Worker (LCSW) license issued by the New… more