- CVS Health (Hartford, CT)
- …in federal and state audits **Required Qualifications** 3 to 5 years of managing healthcare fraud , waste and abuse investigations and audits. 3 to 5 years of ... activities related to the prevention, investigation, and prosecution of health care fraud to recover lost funds. Responsible for compliance with state and federal… more
- Molina Healthcare (Louisville, KY)
- …and actions. + Works with leadership to maintain and revise policies and procedures, fraud , waste , and abuse plans, annual audit work plans, including department ... License, Certification, Association + Active and unrestricted Accredited Health Care Fraud Investigator (AHFI) designation or Certified Fraud Examiner (CFE)… more
- Molina Healthcare (Covington, KY)
- …delivery systems + Understanding of datamining and use of data analytics to detect fraud , waste , and abuse + Proven ability to research and interpret regulatory ... **JOB DESCRIPTION** **Job Summary** Under direct supervision of the Manager , SIU, the Team Lead is responsible to lead a small team of investigators and provide… more
- Providence (OR)
- …education related to coding, medical record documentation requirements, healthcare compliance and fraud , waste and abuse to Health Plan staff, vendors and ... **Description** **Investigator External Audit Special Investigations Unit \*Remote The SIU Audit Investigator supports the compliance related activities of the … more
- UPMC (Pittsburgh, PA)
- …to 4:30 pm This is a remote position. Under the direction of the manager , the Special Investigations Unit (SIU) Investigator is responsible for investigating ... assigned fraud , waste and abuse (FWA) cases, as...cases. This role includes supporting current SIU staff and manager with investigations and special projects. Responsibilities:… more
- Fairview Health Services (Minneapolis, MN)
- …and regulatory compliance **Preferred Experience** + Knowledge of HIPAA privacy and security, Fraud , Waste and Abuse, REMS, DEA ARCOS Reporting, Hazardous ... **Job Overview** The Compliance and Licensing Program Manager is responsible for the development, implementation, and management of the pharmacy licensing program… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …on the specific position **Required Training:** + HIPAA Privacy & Security Course + Fraud , Waste and Abuse Course **Job Skill Requirements:** + Business to ... As the primary point of contact for ProAct clients, the Account Manager is responsible for building relationships with new clients and coordinating internal… more
- Air Combat Command (Tyndall AFB, FL)
- …performance. Administers internal control system to preclude or minimize the potential for fraud , waste , and abuse. Arranges for equipment repairs and other ... at a level that meets current business trends and minimizes waste . Establishes financial goals, prepares budgets, analyzes financial results, maintains solid… more
- Customs and Border Protection (Washington, DC)
- …are covered by internal controls and that appropriate precautions are taken to prevent fraud , waste , and misuse of resources in accordance with the Federal ... United States" pay table. Some positions fall under a special pay rate depending on the series, grade level...of the position. Please visit this link to view special pay rate charts. Requirements Conditions of Employment You… more
- Parsons Corporation (Kingsport, TN)
- …possible. **Job Description:** Parsons is looking for an amazingly talented **Construction Quality Manager (** CQC System Manager ) to join our team! In this ... work. + Coordinate and oversee **testing and inspection activities** , including special inspections for structural steel, welding, concrete, and coatings. + Review… more
- NANA Regional Corporation (Fort Gordon, GA)
- …attention to detail. + Maintains sensitivity to, and report on, instances of fraud , waste and abuse. + Demonstrated knowledge of project management processes ... **Responsibilities** + This position is responsible to the company President/General Manager for the direction, safe operation, compliance, quality delivery and… more
- Point32Health (Canton, MA)
- …prevent future loss. This role will be responsible for conducting high-volume Pre-Payment Fraud Waste & Abuse ("FWA") investigations under the direction of the ... Investigation Unit ("SIU") responsible for leading complex provider investigations related to fraud , waste , and abuse, and developing action plans to address… more
- Aramco Services Company (Houston, TX)
- …conflict of interest, insider trading & anti-trust violations, procurement schemes and fraud . Involves in special inquiry investigations, that require a high ... be completed. + Conducts objective, thorough, and timely investigations into allegations of fraud , waste or abuse committed by employees or contractors against… more
- CVS Health (Richmond, VA)
- …Python who can transform complex healthcare data into actionable insights to support fraud , waste , and abuse (FWA) detection and Medicaid regulatory & compliance ... + Design, develop, and maintain complex data analyses to support investigations of potential fraud , waste , and abuse in Medicaid claims and provider activity. +… more
- Centene Corporation (Frankfort, KY)
- …as a subject matter expert for the Contractor's Program Integrity unit to reduce Fraud , Waste and Abuse of Medicaid services within Kentucky. Provides direction ... guidance to staff who investigate and remediate compliance and fraud , waste , and abuse related matters; while...an investigative workload of moderate to high complexity. Assists manager on monitoring team caseload and report on metrics.… more
- Army National Guard Units (Carson City, NV)
- …for filing IG complaints or IGARs. (4) Assists in the establishment and implements the Fraud , Waste and Abuse (FWA) program in accordance with United States Army ... guidelines set out in the Department of Defense (DoD) Hotline program for reporting Fraud , Waste and Abuse complaints. (5) As required, assists members of the… more
- UnityPoint Health (Sioux City, IA)
- …requirements for federally funded healthcare programs (eg Medicare and Medicaid) regarding fraud , waste and abuse. Brings any questions or concerns regarding ... products, etc. to provide the menu selections for patient, cafeteria, special function and satellite accounts while meeting productivity levels. Is knowledgeable… more
- Covenant Health Inc. (Knoxville, TN)
- …Performs other duties as needed. Reports to the Revenue Integrity Manager . Recruiter: Suzie McGuinn || ###@covhlth.com Responsibilities Integrity + Identifies and ... by CMS and the OIG via the Federal Register, fraud alerts, OIG advisory opinions, and other publications relative...Assists with payor denials when necessary. + Assists with special projects and performs other duties as needed and… more
- Idaho Division of Human Resources (Pocatello, ID)
- …or information technology components. Work can also include investigating allegations of fraud , waste and abuse. + Completes all assignments within established ... engagements with minimal supervision from the Systemwide CAE, a Systemwide Internal Audit Manager or a project lead. All work is performed to fulfill completion of… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …this position is responsible for the accurate and thorough clinical investigation of potential fraud , waste and abuse (FWA) for all lines of business. The scope ... + Prepares recommendations on preventive/corrective measures for the deterrent of future fraud . + Supports other SIU investigators and analysts with their cases by… more