- 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)
- **Working Title: Medicaid Provider Audits and Investigations (MPAI) Supervisor** **Job Class: Human Services Supervisor 3** **Agency: Human Services ... The Department of Human Services (DHS) is unable to provide sponsorship for work visas. Applicants must be eligible...the section. + To administer the Medicaid Provider Audits & Investigations (MPAI)… 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
- 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
- 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 Michigan (Grand Rapids, MI)
- …This position is responsible for the full range of professional on-site or in-house audits and/or investigations for all Department of Health and Human Services ... responsible for performing the most complex on-site or in-house audits , reviews, or conducts investigations of nursing...purpose is to satisfy the federal mandate for auditing Medicaid Providers and to ensure that the provider… 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
- 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
- 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
- MyFlorida (Tallahassee, FL)
- …of HQA as needed, for coordinated response and remediation, which may include audits , investigations , or field operation initiatives. Perform other duties as ... for Health Quality Assurance with overall division functions. This position will provide subject matter expertise and project coordination with all six bureaus… more
- University of Rochester (Rochester, NY)
- …as formal self-disclosures or claim adjustments + Assists in responding to external audits and government investigations as directed. + Participates in special ... considerations._ **Responsibilities:** GENERAL PURPOSE The Compliance Analyst II conducts investigations , risk assessments, and regulatory monitoring to prevent and… more
- Humana (Carson City, NV)
- …and documentation to support successful adjudication, where appropriate. Conducts on-site audits of provider records ensuring appropriateness of billing ... The individual in this position acts as the primary liaison for the Virgina Medicaid . They coordinate all Medicaid FWA activities in Virgina to enhance the… 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
- 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
- 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
