- Molina Healthcare (ID)
- …operations of the Compliance Program, Compliance Plan, Code of Conduct, and Fraud , Waste and Abuse Plan across the enterprise while ensuring compliance with ... for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- Molina Healthcare (Lexington, KY)
- …reporting, and when appropriate, recovery of money related to health care fraud , waste, and abuse. Duties include performing accurate and reliable medical review ... Counsel, and Medical Officers in order to achieve and maintain appropriate anti- fraud oversight. **Job Duties** + Responsible for developing leads presented to the… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …protocols specific to hospital revenue cycle risk areas highlighted by the OIG, Medicare , State Medicaid, State Insurance Fraud ; Managed Care or Governmental ... for the development of compliance internal monitors and audit protocols and the prevention of fraud , waste and abuse. + Develops compliance monitors and audit… more
- Zelis (Plano, TX)
- …So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more ... top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across… more
- Prime Healthcare (Dallas, TX)
- Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360 ... nearly 57,000 employees and physicians. Eighteen of the Prime Healthcare hospitals are members of the Prime Healthcare...the Antikickback Statute, the False Claims Act, and other Fraud , Waste and Abuse laws and regulations, along with… more
- Grant Thornton (Los Angeles, CA)
- …for business and IT process optimization, profit improvement, cost reduction, fraud prevention, internal control, and compliance. + Perform engagement management ... 4 years of direct experience with diverse life sciences companies or healthcare providers, including hospitals, academic medical centers, healthcare systems, and… more
- CVS Health (Charleston, WV)
- …you will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high ... involving multi-lines of business, or cases involving multiple perpetrators or intricate healthcare fraud schemes. + Investigates to prevent payment of… more
- State of Georgia (Fulton County, GA)
- …Georgia Medicaid Program. Participates as a member of an interdisciplinary team in Healthcare fraud investigations, and provides support to members of other ... services and eligibility of providers as requested. + Assists prosecutors in Healthcare Fraud investigations by reviewing provider and patient records. +… more
- KPH Healthcare Services, Inc. (Oklahoma City, OK)
- …plans and any changes that possibly may occur within the Insurance Payor, Medicare , or Medicaid + Responsible for completing all mandatory and regulatory training ... the specific position **Required Training:** + HIPPA Privacy & Security Course + Fraud , Waste, and Abuse Course **Job Skills Required:** + Exceptional attention to… more
- CVS Health (Albany, NY)
- …and every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Dental/Pharmacy/Broker Investigative Team ... role, you will manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct high… more
- NTT America, Inc. (Plano, TX)
- … client accounts in ensuring our organization meets its HIPAA and healthcare -compliance-related obligations, including Medicare and Medicaid standards. This role ... healthcare clients, including facilitating exclusion searches, internally auditing healthcare accounts, providing attestations for Medicare and Medicaid… more
- Atlantic Health System (Morristown, NJ)
- …prior experience with hospitals, Medicare and Medicaid, and federal and state healthcare regulatory issues, including fraud and abuse, the Stark Law, the ... monitoring of regulatory developments, and legal research on regulatory issues, including fraud and abuse issues, HIPAA compliance, EMTALA, Medicare and Medicaid… more
- Humana (Indianapolis, IN)
- …Dual Eligible Special Needs Plans (DSNP), which serve members who qualify for both Medicare and Medicaid. They will lead the state Medicaid executive team and report ... with federal and state laws and programmatic requirements, including fraud , waste, and abuse; make decisions in an ethical...new ideas and initiatives from across the Medicaid and healthcare industry + Effectively support the growth of associates… more
- Highmark Health (Lincoln, NE)
- …charges; will monitor internal referrals from sources such as claims, customer service, Medicare C&D Compliance, and Fraud Hotlines; will alert Investigators of ... in the interviews of customers and providers to obtain information in suspected fraud waste and abuse cases; Prepare reports and other information to document audit… more
- Executive Office for US Attorneys and the Office of the US… (Sacramento, CA)
- …Affirmative Civil Enforcement: Responsibilities include enforcement investigations and litigation involving healthcare fraud , procurement fraud , grant ... the National Environmental Policy Act and other environmental statutes; Social Security, Medicare , and other federal programs; and "Bivens" civil rights actions. The… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- … Medicare Advantage risk adjustment methodology, coding guidelines (ICD-10-CM), healthcare compliance, and billing practices. * Proficiency in Excel and ... are looking for dedicated and motivated individuals who share our vision of transforming healthcare . As a Blue Cross associate, you are joining a culture that is… more
- Zelis (Plano, TX)
- …So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more ... top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across… more
- Baylor Scott & White Health (Dallas, TX)
- …individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core ... and accreditation standards, such as the Joint Commission, Centers for Medicare and Medicaid (CMS), National Committee for Quality Assurance (NCQA), Health… more
- AssistRx (Orlando, FL)
- …Knowledge of regulatory requirements affecting pharmacy and medical copay programs, including healthcare compliance and fraud prevention. + . Ability to analyze ... comply with all federal, state, and industry regulations, including anti-kickback statutes, Medicare /Medicaid rules, FDA and OIG guidance. + Work closely with the… more
- State of Colorado (Denver, CO)
- …CBI name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure ... expiration timelines and tracking documentation for regulatory compliance, including Medicare /Medicaid requirements. + Assists with procurement processes, coordinates with… more