- BlueCross BlueShield of North Carolina (NC)
- …experience in related field. **Preferred Qualifications/Skills** + 3 years of Pharmacy Fraud , Waste and Abuse investigations and/or pharmacy auditing ... **Job Description** The Sr Pharmacy Fraud Investigations Analyst is responsible...and conducts presentations and/or provides content for health care fraud and abuse education and awareness **Hiring… more
- Health First (Rockledge, FL)
- …practices and quality standards. 6. Analyze pharmacy claims data for potential Fraud Waste , and Abuse (FWA), compliant claim adjudication, patient ... but are not limited to oversight of the daily pharmacy program operations and the contracted Pharmacy ...daily pharmacy program operations and the contracted Pharmacy Benefits Manager (PBM). Ensure achievement of organizational and… more
- MyFlorida (Tallahassee, FL)
- … Fraud Analysts and will perform data mining and investigative activities to identify fraud , waste , or abuse in claims data within our program. ... Analysts will identify outliers and trends based on relevant fraud , waste , and abuse topics;...sets. + Proactively identify new and emerging medical & pharmacy fraud schemes through research and use… more
- The Cigna Group (St. Louis, MO)
- …result in an in-depth referral to impacted clients. **ESSENTIAL FUNCTIONS** + Perform fraud , waste , and abuse virtual investigations of members identified ... to plan sponsors and Government agencies with actionable information to manage and mitigate fraud , waste , and abuse . **QUALIFICATIONS** + Clear and concise… more
- Prime Therapeutics (Columbus, OH)
- …Description Summary** Responsible for the intake and initial handling of allegations of fraud , waste or abuse . Conducts preliminary investigation to assess ... audit or investigation. Serves as a corporate resource on fraud , waste and abuse issues...model and processes, preferably in behavioral health, radiology or pharmacy . + 3+ years' fraud investigations/claims experience.… more
- KPH Healthcare Services, Inc. (Lancaster, PA)
- …drug screening test **Required Training:** + HIPPA Privacy Course + HIPPA Security Course + Fraud , Waste , and Abuse Course + HIPPA Privacy CE Mastery Exam ... the HealthDirect team has been dedicated to the unique pharmacy needs of individuals residing in Long-Term Care (LTC)...+ HIPPA Security CE Mastery Exam + Fraud , Waste , and Abuse CE… more
- KPH Healthcare Services, Inc. (Marcy, NY)
- …drug screening test **Required Training:** + HIPPA Privacy Course + HIPPA Security Course + Fraud , Waste , and Abuse Course + MethGuard Course + HIPPA Privacy ... the HealthDirect team has been dedicated to the unique pharmacy needs of individuals residing in Long-Term Care (LTC)...Mastery Exam + HIPPA Security CE Mastery Exam + Fraud , Waste , and Abuse CE… more
- KPH Healthcare Services, Inc. (Farmington, MO)
- …drug screening test **Required Training:** + HIPPA Privacy Course + HIPPA Security Course + Fraud , Waste , and Abuse Course + MethGuard Course + HIPPA Privacy ... the HealthDirect team has been dedicated to the unique pharmacy needs of individuals residing in Long-Term Care (LTC)...Mastery Exam + HIPPA Security CE Mastery Exam + Fraud , Waste , and Abuse CE… more
- Kinney Drugs (North Syracuse, NY)
- …drug screening test Required Training: + HIPPA Privacy Course + HIPPA Security Course + Fraud , Waste , and Abuse Course + MethGuard Course + HIPPA Privacy ... the HealthDirect team has been dedicated to the unique pharmacy needs of individuals residing in Long-Term Care (LTC)...Mastery Exam + HIPPA Security CE Mastery Exam + Fraud , Waste , and Abuse CE… more
- Kinney Drugs (Williston, VT)
- …drug screening test Required Training: + HIPPA Privacy Course + HIPPA Security Course + Fraud , Waste , and Abuse Course + MethGuard Course + HIPPA Privacy ... the HealthDirect team has been dedicated to the unique pharmacy needs of individuals residing in Long-Term Care (LTC)...Mastery Exam + HIPPA Security CE Mastery Exam + Fraud , Waste , and Abuse CE… more
- KPH Healthcare Services, Inc. (Greensboro, NC)
- …drug screening test **Required Training:** + HIPPA Privacy Course + HIPPA Security Course + Fraud , Waste , and Abuse Course + MethGuard Course + HIPPA Privacy ... and store medications/supplies while ensuring appropriate stocking levels in pharmacy + Perform physical inventories according to P&Ps +...Mastery Exam + HIPPA Security CE Mastery Exam + Fraud , Waste , and Abuse CE… more
- KPH Healthcare Services, Inc. (Lancaster, PA)
- …drug screening test **Required Training:** + HIPAA Privacy Course + HIPAA Security Course + Fraud , Waste , and Abuse Course + MethGuard Course + HIPAA Privacy ... the HealthDirect team has been dedicated to the unique pharmacy needs of individuals residing in Long-Term Care (LTC)...CE Mastery Exam + Fraud , Waste , and Abuse CE...CE Mastery Exam + Fraud , Waste , and Abuse CE Mastery Exam +… more
- SSM Health (Mount Vernon, IL)
- …quantity, MME, source and DAW to avoid audit charge backs and ensure compliance with Fraud Waste and Abuse (FWA) Laws. + Contributes to zero medication ... is a PRN (as needed) position working variable shift in our Retail Pharmacy . Join our exceptional team! **Job Summary:** Assures the appropriate selection, dosing,… more
- KPH Healthcare Services, Inc. (Gouverneur, NY)
- …drug screening test **Required Training:** + HIPPA Privacy Course + HIPPA Security Course + Fraud , Waste , and Abuse Course + MethGuard Course + HIPPA Privacy ... of all dispensings + Assist other areas of the pharmacy as needed daily + May assist in orienting...Mastery Exam + HIPPA Security CE Mastery Exam + Fraud , Waste , and Abuse CE… more
- KPH Healthcare Services, Inc. (Flowood, MS)
- …drug screening test **Required Training:** + HIPPA Privacy Course + HIPPA Security Course + Fraud , Waste , and Abuse Course + MethGuard Course + HIPPA Privacy ... + Minimum: High School Diploma or GED + Preferred: Pharmacy technician or related certification **Experience:** + Past experience...Mastery Exam + HIPPA Security CE Mastery Exam + Fraud , Waste , and Abuse CE… more
- Elevance Health (Altamonte Springs, FL)
- …+ NPI profile updates (NPPES). URAC, ACHC, NABP support during accreditation renewals. + Fraud , Waste and Abuse annual attestation submission to health ... a check, or ask you for payment as part of consideration for employment. ** Pharmacy Credentialing Analyst** + Job Family: PND > Credentialing & Licensing + Type:… more
- Baptist Memorial (Covington, TN)
- …billing guidelines and complete required training pursuant to BSP policies and procedures (eg, fraud , waste , and abuse training) + Answer insurance and ... to ensure patients are getting the most out of their specialty pharmacy services. The Pharmacy Technician - Specialty Pharmacy is responsible for dispensing… more
- Omnicell, Inc. (Fort Worth, TX)
- …Billing and coding process compliance + Healthcare fraud , waste and abuse compliance + 340B Program compliance + Pharmacy and pharmacist licensing + ... **Sr. Manager, Pharmacy Operations Compliance - Remote ** The Sr.... Operations Compliance - Remote ** The Sr. Manager, Pharmacy Operations Compliance is responsible for tracking, monitoring, reviewing,… more
- KPH Healthcare Services, Inc. (Concord, NH)
- …screening test **Required Training:** + HIPPA Privacy Course + HIPPA Security Course + Fraud , Waste , and Abuse Course + MethGuard Course **Behavioral Traits ... For over 50 years, the HealthDirect team has been dedicated to the unique pharmacy needs of individuals residing in Long-Term Care (LTC) facilities such as nursing… more
- The Cigna Group (Bloomfield, CT)
- …Opioid Edits, Pharmacy & Therapeutics (P&T), End Stage Renal Disease (ESRD/ Hospice, Fraud , Waste and Abuse (FWA,) and Clinical Decision Making_ **Role ... Summary** The Medicare Part D Legal Compliance Advisor is responsible for compliance support of service operations with specific focus on Medicare clinical programs. The Advisor will ensure operational compliance with all regulatory requirements and standards… more