- CAPPS (Austin, TX)
- …enforcement officer TCOLE certification Knowledge of TCOLE training requirements and healthcare fraud investigation training needs Knowledge of Microsoft Office ... of the MFCU documentation and report writing system or a like system Knowledge of healthcare fraud statutes (state and federal) TO APPLY To apply for a job… more
- Public Health Trust of Dade Co (Miami, FL)
- …of the world's most skilled and highly regarded multidisciplinary team of healthcare professionals. Summary The Assistant Director of Regulatory Affairs is a member ... for surveys (ie, State, The Joint Commission, Center for Medicare and Medicaid Services, AHCA), conducts quality and patient...is committed to its role in preventing health care fraud and abuse and complying with applicable state and… more
- Advanced Urology Institute (Oxford, FL)
- …using computer programs and applications including Microsoft Office. Knowledge in healthcare systems operations and experience in navigating EMRs. Ability to answer ... knowledge of health insurance products (HMO, PPO, HSA, Commercial, Medicare etc.). Ability to navigate online health insurance portals...for Parts C & D on General Compliance and Fraud , Waste & Abuse. Complies with HR confidentiality standards.… more
- Integrated Medical Professionals PLLC (Garden City, NY)
- …using computer programs and applications including Microsoft Office. Knowledge in healthcare systems operations and experience in navigating EMRs. Ability to answer ... knowledge of health insurance products (HMO, PPO, HSA, Commercial, Medicare etc.). Ability to navigate online health insurance portals...for Parts C & D on General Compliance and Fraud , Waste & Abuse. Complies with HR confidentiality standards.… more
- University of Maryland Medical System (La Plata, MD)
- …of Maryland Medical System, where we combine the resources of a top-tier healthcare network with the personal touch of a community hospital. Here, you'll enjoy ... Recognized as a 4-star hospital by the Centers for Medicare and Medicaid Services (CMS) and honored with the...banking details, personal identification, or payment via email or text. If you suspect fraud , please contact us at… more
- Southern Jersey Family Medical Centers (Atlantic City, NJ)
- …applicable federal and state and local laws, including but not limited to HIPPA, Medicare Fraud and Abuse Act, NJ DOH License Ambulatory regulations, DEPE: etc. ... degree At least 2 years of related work experience in a healthcare setting Previous management experience required Valid driver's license Strong computer skills… more
- CVS Health (Hartford, CT)
- …each and every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU). ... role, you will manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct high… more
- 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 (St. Petersburg, FL)
- …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
- Prime Healthcare (Ontario, CA)
- 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
- 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
- Aveanna Healthcare (Homestead, FL)
- …per hour Position Details CLINICAL RESEARCH NURSE - Illingworth (RN) Job Overview: Aveanna Healthcare is seeking nurses ie Registered Nurses to act as a key member ... that may be required Report any suspected misconduct or fraud to Aveanna & Illingworth and associated companies Where...have visual and hearing acuity As an employer accepting Medicare and Medicaid funds, employees must comply with all… 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
- Corewell Health (Grand Rapids, MI)
- …experience fraud and abuse experience or equivalent combination of; auditing, healthcare fraud and abuse, compliance, or regulatory (ie, CMS & Medicaid) ... Unit (SIU) with a focus on identifying, investigating, and resolving health insurance fraud , waste, and abuse (FWA). This role provides operational oversight to the… 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
- Robert Half Legal (Westminster, CO)
- …licensing, operational issues (eg, governance, organizational structure, and compliance programs), healthcare fraud and abuse (eg, anti-kickback, Stark, and ... licensing, operational issues (eg, governance, organizational structure, and compliance programs), healthcare fraud and abuse (eg, anti-kickback, Stark, and… 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
- Cambridge Health Alliance (Cambridge, MA)
- …our participants. This role is responsible for overseeing Medicaid and Medicare enrollment, claims, reporting, risk adjustment, compliance, contract management, and ... they pertain to Health Plan Operations. * Manage all aspects of Medicare and Medicaid enrollment, retention, dis-enrollment, and long-term care transitions. * Ensure… more
- Amentum (Albany, NY)
- …data analytics. + Support development of internal best practices and workflows for healthcare fraud detection. **Required Qualifications:** + Must be able to ... business entities, and assets. + Analyze large and complex healthcare claims datasets to identify fraud , waste,...the specific subject matter area involved - for example, Medicare billing and claims systems, or DoD inventory systems.… more
