- CVS Health (Richmond, VA)
- …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 (Richmond, VA)
- …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 (Richmond, VA)
- …+ 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
- Elevance Health (Richmond, VA)
- …independent identification, investigation and development of complex cases against perpetrators of healthcare fraud in order to recover corporate and client ... claims. + Responsible for independently identifying and developing enterprise-wide specific healthcare investigations and initiatives that may impact more than one… more
- Elevance Health (Richmond, VA)
- **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
- Amazon (Arlington, VA)
- …in one state bar or equivalent - 5+ years of legal experience - Healthcare regulatory experience, eg fraud waste and abuse laws, telehealth regulations, direct ... Description We are looking for a talented healthcare transactions counsel to help reinvent primary care for customers. This role supports the strategic growth… more
- ICF (Reston, VA)
- …the larger organization. Projects have included augmenting technical assistance teams for healthcare , data extraction and fraud detection for energy utilities, ... and natural language exploration of large datasets. Our clients include both internal teams and external clients. We're looking for an experienced senior full-stack developer to join our team and help shape both our technical architecture and product direction… more
- Robert Half Legal (Glen Allen, VA)
- …experience in drafting motions, briefs, and discovery documents. * Familiarity with healthcare law, including HIPAA, telemedicine, and fraud and abuse ... and deliver effective solutions. Responsibilities: * Provide legal counsel to healthcare organizations on board governance, licensing, and investigative matters. *… more
- DXC Technology (Stafford, VA)
- …DC, NY or Dallas** **Job Description** Join **DXC Technology** as the Global ** Healthcare and Life Sciences (HLS) and Consumer and Retail (CR) Industry Leader** ... Qualifications, Capabilities, and Skills** + Extensive experience (15+ years) in ** Healthcare and Life Sciences** , with deep expertise across consulting, technology… more
- Elevance Health (Roanoke, VA)
- …for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. **How you will make an impact:** + Examines claims for ... compliance with relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control. + Reviews and conducts analysis… more