- CVS Health (Trenton, NJ)
- …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 (Trenton, NJ)
- …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 (Trenton, NJ)
- …+ 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
- AbbVie (Florham Park, NJ)
- …legal issues, including advertising, promotion, antitrust, market access, pricing, reimbursement, healthcare fraud , abuse, and anti-bribery, for both on-market ... and pipeline products. The primary focus is on international strategic priorities, and this role reports directly to the Senior Counsel for IMCO and IMAP. Key Responsibilities Include: + Serve as the strategic and legal lead counsel for pharmaceutical brands… more
- Elevance Health (Woodbridge, NJ)
- **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 days ... to recover, eliminate and prevent unnecessary medical-expense spending. The **Clinical Fraud Investigator II** is responsible for identifying issues and/or entities… more
- Atlantic Health System (Morristown, NJ)
- …including prior experience with hospitals, Medicare and Medicaid, and federal and state healthcare regulatory issues, including fraud and abuse, the Stark Law, ... diligence process. -Serve as a key subject matter resource on healthcare laws and regulations, including, without limitation, monitoring of regulatory developments,… more
- City National Bank (Trenton, NJ)
- …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. (Trenton, NJ)
- …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
- Sanofi Group (Morristown, NJ)
- …complex and wide-ranging legal matters, particularly in the area of advertising and promotion, fraud and abuse and other applicable healthcare laws, as well as ... pharmaceutical companies on marketing, distribution, promotion, scientific exchange, and healthcare professional interactions. This role requires efficient prioritization of… more
- Otsuka America Pharmaceutical Inc. (Trenton, NJ)
- **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