- BlueCross BlueShield of North Carolina (NC)
- …$62,100.00 - $111,800.00 **Skills** Depositions, Evidence Collection, Forensic Accounting, Fraud Investigations , Investigation Techniques, Investigative ... is responsible to conduct timely and thorough health care fraud investigations on behalf of the Company....gaps on the business/organization. + In the course of investigation , may be required to provide deposition and/or testimony… more
- State of Colorado (Arapahoe County, CO)
- …CBI name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure ... all subject areas. + Pass CBI and FBI background investigations + The Diana Screen(R), a sexual risk screening...Veterans Community Living Centers). + Included in the background investigation is a current/previous employer check. Your current and… more
- State of Colorado (Jefferson County, CO)
- …CBI name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure ... of fingerprinting, polygraph, drug screen, physical exam and an extensive background investigation ) will be conducted as part of the selection process. Felony… more
- Methodist Health System (Dallas, TX)
- …including, but not limited to, state specific health care laws and regulations, Medicare /Medicaid rules, fraud and abuse including Stark and anti-kickback laws ... and state laws relating to healthcare, including but not limited to Medicare /Medicaid reimbursement, HIPAA, AKS, self-referral prohibitions, and fraud and abuse.… more
- CVS Health (Hartford, CT)
- …and every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU). In ... investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct...federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud . +… more
- Amentum (Baltimore, MD)
- …anomalies that might be indicative of improper billing or other types of fraud . + Initiate contacts with federal, state, and local officials, and other ... organizations, including Medicare and Medicaid contractors, related to the subject of...and Medicaid contractors, related to the subject of the investigation for the purpose of gathering facts, obtaining records,… more
- Corewell Health (Grand Rapids, MI)
- …of the Special Investigation Unit (SIU), ensuring timely and thorough investigation of potential fraud , waste, and abuse (FWA) cases. Provide coaching, ... Job Summary - Manager Special Investigation Unit The SIU Manager is responsible for...a focus on identifying, investigating, and resolving health insurance fraud , waste, and abuse (FWA). This role provides operational… more
- Molina Healthcare (ID)
- …for compliance by overseeing, follow-up and resolution of investigations . **Knowledge/Skills/Abilities** * Assists with implementation and day-to-day operations ... of the Compliance Program, Compliance Plan, Code of Conduct, and Fraud , Waste and Abuse Plan across the enterprise while ensuring compliance with governmental… more
- UnityPoint Health (Anamosa, IA)
- …hospital and department compliance requirements for federally funded healthcare programs (eg Medicare and Medicaid) regarding fraud , waste and abuse. Brings any ... emergency and routine requests for service. Documents relevant incidents, conducts investigations as appropriate, monitors security cameras and other equipment as… more
- UnityPoint Health (Sioux City, IA)
- …hospital and department compliance requirements for federally funded healthcare programs (eg Medicare and Medicaid) regarding fraud , waste and abuse. Brings any ... Quality Assurance (QA) and Resource Management + Assists and completes investigations involving unexpected or adverse outcomes and keeps documentation according to… more
- Molina Healthcare (St. Petersburg, FL)
- …opinions. + Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations . + Knowledge of Managed Care and the Medicaid and ... medical records and data analysis, and makes determinations as to whether the investigation and/or audit identified potential fraud , waste, or abuse. +… more
- State of Georgia (Fulton County, GA)
- …Medicaid Program. Participates as a member of an interdisciplinary team in Healthcare fraud investigations , and provides support to members of other disciplines ... of providers as requested. + Assists prosecutors in Healthcare Fraud investigations by reviewing provider and patient...claims and/or claims data; experience in the detection and investigation of healthcare fraud . Additional Information +… more
- Highmark Health (Austin, TX)
- …including auditing/monitoring operational processes, conducting or overseeing compliance investigations , and ensuring that adequate training takes place under ... and external audit progress, recurring risk and compliance reporting, mandated training, investigations , and the impacts of new and changing laws, regulations, and… more
- Travelers Insurance Company (Irvine, CA)
- …a settlement should be considered. **What Will You Do?** + Conduct investigations , including, but not limited to assessing policy coverage, contacting insureds, ... to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome.… more
- Option Care Health (Milwaukee, WI)
- …the regulatory landscape, with a strong focus on preventing, detecting, and addressing fraud , waste and abuse (FWA). This leader promotes a culture of integrity and ... expert in health care compliance including, but not limited to FWA, Medicare & Medicaid billing requirements, and interactions with healthcare professionals. Lead or… more
- Baylor Scott & White Health (Temple, TX)
- …and related information. - Oversees the development and implementation of anti- fraud program, including the coordination of internal investigations , ... and accreditation standards, such as the Joint Commission, Centers for Medicare and Medicaid (CMS), National Committee for Quality Assurance (NCQA), Health… more
- NJM Insurance (Trenton, NJ)
- …workers, medical providers, the NJM Medical Claims Services Department, the NJM Special Investigation Unit, the NJM WC Legal Staff, and other departments within NJM, ... of timely, appropriate, and accurate benefits + Evaluate the claim for potential fraud indicators and escalates the file to SIU, as appropriate + Recognize and… 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, ... by CMS and the OIG via the Federal Register, fraud alerts, OIG advisory opinions, and other publications relative...coding, modifiers and billing processes to ensure compliance with Medicare , Medicaid guidelines and other insurance payors and to… more
- Parkview Health (Fort Wayne, IN)
- …for the operation of the compliance program with an emphasis on Medicare /Medicaid billing compliance and HIPAA compliance. Serve as the Parkview Health Privacy ... understanding of applicable federal and state billing regulations and statutes ( Medicare & Medicaid). Demonstrates knowledge of HIPAA Privacy & Security regulations,… more
- City of New York (New York, NY)
- …mining, data analytics, data reporting, database hosting and systems used for fraud investigation , revenue collection activities and tracking. Ensure business ... of Accountability Strategies (OAS), Compliance and Contract Monitoring (CCM), Investigation , Revenue and Enforcement Administration (IREA), Office of Data Security… more