- Molina Healthcare (Boise, ID)
- …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
- CVS Health (Boise, ID)
- …investigators and analysts to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to ... a team in the planning and execution of investigations of acts of healthcare fraud and abuse by both members and providers. Provides direction and counsel on… more
- Highmark Health (Boise, ID)
- …3 years of relevant, progressive experience in the health insurance industry and/or healthcare fraud investigations **Preferred** + 1 year in Financial Analysis ... Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider… more
- Prime Therapeutics (Boise, ID)
- …+ Analyze data to find suspicious patterns and outliers using knowledge of healthcare coding conventions, fraud schemes, and general areas of vulnerability. + ... for the intake and initial handling of allegations of fraud , waste or abuse. Conducts preliminary investigation to assess...audit or investigation. Serves as a corporate resource on fraud , waste and abuse issues and maintains confidentiality and… more
- Molina Healthcare (Caldwell, ID)
- …Enforces, as a representative of management, the Compliance Plan, Code of Conduct and Anti- Fraud Plan. * Establishes, at the direction of the AVP of Compliance or ... an active relationship with third parties who have specific experience in conducting fraud and abuse investigations. * Prepares written reports to inform the AVP of… 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 (Caldwell, ID)
- …Security Professional (CISSP) or Certified Information Security Manager (CISM), Certified Fraud Examiner (CFE), etc. + Professional organization membership such as ... for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- City National Bank (Boise, ID)
- …handling lender self-reporting requirements, and coordinating regulatory audits and fraud reporting. The ideal candidate brings strong analytical skills, attention ... * Manage the intake, documentation, and submission of suspected or confirmed fraud to the appropriate internal departments and external agencies. * Ensure compliance… more
- Otsuka America Pharmaceutical Inc. (Boise, ID)
- …therapeutic areas. This role operates as a crucial liaison between healthcare providers (HCPs), internal teams, and external stakeholders to facilitate appropriate ... requirements + Analyze payer criteria and provide product access expertise to healthcare offices + Coordinate with Hubs on individual patient cases, including… more
- Otsuka America Pharmaceutical Inc. (Boise, ID)
- **Company Overview:** Otsuka is a global healthcare company driven by our purpose "to defy limitation, so that others can too." Patients are at the center of our ... purpose as we seek to discover and deliver innovative healthcare solutions. Otsuka is a leader in the CNS therapeutic area (TA), which is comprised of a strong… more