- State of Minnesota (St. Paul, MN)
- **Working Title: Medicaid Provider Audits and Investigations Manager** **Job Class: Human Services Manager 2** **Agency: Human Services Dept** + **Job ... The incumbent manages anti-fraud, waste, and abuse efforts, including provider investigations , prevention, education, and enforcement activities.… more
- CVS Health (St. Paul, MN)
- …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
- State of Minnesota (St. Paul, MN)
- …not limited to: + Directandmanage thescopeoftheRAC, UPIC,andothercontractor audits . + Actasliaison oncontractormatters withproviders, provider associations,other ... : Yes The Department of Human Services (DHS) is unable to provide sponsorship for work visas. Applicants must be eligible to work in… more
- Humana (St. Paul, MN)
- …and documentation to support successful adjudication, where appropriate. Conducts on-site audits of provider records ensuring appropriateness of billing ... The Fraud and Waste Professional 2 is responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving Florida's Medicaid… more
- Cardinal Health (St. Paul, MN)
- …policies, educates and trains employees across the organization, and conducts investigations to resolve ethics and compliance issues. **Compliance Audit Manager** ... to the Compliance Director, this position supervises and manages compliance audits to determine organizational integrity of billing for professional (physician)… more
- State of Minnesota (St. Paul, MN)
- …problem resolution skills in order to manage the investigation and resolution of Medicaid provider cases. + Experience establishing a Risk and Mitigation Plan. ... : Yes The Department of Human Services (DHS) is unable to provide sponsorship for work visas. Applicants must be eligible to work in… more
- Highmark Health (St. Paul, MN)
- …policies, and procedures of governmental, contractual, and/or corporate entities. Provide consultation and analytic support to assigned functional areas. ... of rules, regulations, policies, and procedures and assist with appropriate audits , as applicable. Contacts may include legislators, consumers, special interest… more