- 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
- CVS Health (St. Paul, MN)
- …- 3+ years' in healthcare field working in fraud, waste and abuse investigations and audits . - Proficient in researching information and identifying information ... depositions, etc. **Preferred Qualifications** - Knowledge of New Jersey Medicaid - Credentials such as a certification from the...years working in health care fraud, waste, and abuse investigations and audits . **Anticipated Weekly Hours** 40… 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
- MyFlorida (Tallahassee, FL)
- …The Bureau of Medicaid Program Integrity (MPI) does this specifically through audits and investigations of Medicaid providers, including managed care ... report to work daily and on time. The Florida Medicaid program is one of the five largest in...and champion in the Statewide Travel Management System (STMS). Provide coordination of Bureau training, conferences, travel activities, and… more
- MyFlorida (Tallahassee, FL)
- …The Bureau of Medicaid Program Integrity (MPI) does this specifically through audits and investigations of Medicaid providers, including managed care ... report to work daily and on time. The Florida Medicaid program is one of the five largest in...be made in advance to allow sufficient time to provide the accommodation. The State of Florida supports a… 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
- Clark County, NV (Las Vegas, NV)
- …Management Analyst. This position will support the Fiscal, Grants, Contracts, and Medicaid program operations. These supervisory positions provide leadership and ... Services Manager. Medicaid Unit: Senior Management Analysts assigned to the Medicaid /Billing Program Unit will provide leadership and oversight of all … more
- MyFlorida (Tallahassee, FL)
- …as a desire to innovate. The selected candidate will assist in conducting investigations / audits related to fraud, abuse, and waste through research and analysis ... will support the fraud and abuse prevention efforts within the Bureau of Medicaid Program Integrity (MPI). MPI is organized by the functions that fall within… 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
- AmeriHealth Caritas (Columbia, SC)
- …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
- MyFlorida (Tallahassee, FL)
- … program and be able to accurately apply software programs needed to complete investigations and audits . Applicants should also possess the ability to review and ... to fill a Medical Health Care Program Analyst position within the Bureau of Medicaid Program Integrity (MPI). MPI is the Agency's lead unit responsible for oversight… 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
- MyFlorida (Tampa, FL)
- …investigator on cases involving suspected Cost Report Fraud and Prospective Payment System Medicaid provider fraud involving: 1) Nursing Homes, 2) Hospitals, and ... experience regarding Medicaid Laws and Regulations and the ability to provide financial expertise to the investigative team by: 1) Reviewing resident trust… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …conduct education as necessary. + Coordinate, assist and/or conduct billing compliance investigations as required, which may include audits designed to review ... of Dana-Farber Cancer Institute's hospital and professional billing through data-driven audits and targeted monitoring. This role conducts complex, risk-based … 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
- Molina Healthcare (Covington, KY)
- …back-up to the SIU Manager. This position will be accountable for tracking on investigations conducted by his/her team and will provide oversight and guidance ... assessment that QA measures were complete and signed-off + Provide guidance to investigators as needed on investigative techniques,...investigations + Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace +… more
- MVP Health Care (Tarrytown, 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
- 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