- CVS Health (Des Moines, IA)
- …of investigators and analysts to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse , to recover lost funds, and ... Leads a team in the planning and execution of investigations of acts of healthcare fraud and abuse by both members and providers. Provides direction and… more
- Molina Healthcare (Davenport, IA)
- …investigation, reporting, and when appropriate, recovery of money related to health care fraud , waste, and abuse . Duties include performing accurate and reliable ... for developing leads presented to the SIU to assess and determine whether potential fraud , waste, or abuse is corroborated by evidence. + Conducts both… more
- Elevance Health (West Des Moines, IA)
- …responsible for identifying issues and/or entities that may pose potential risks associated with fraud and abuse . **How you will make an impact:** + Performs ... billing and processing guidelines and to identify opportunities for fraud and abuse prevention and control. +...claims and medical records prior to payment. Researches new healthcare -related questions as necessary to aid in investigations. +… more
- Highmark Health (Des Moines, IA)
- …3 years of relevant, progressive experience in the health insurance industry and/or healthcare fraud investigations **Preferred** + 1 year in Financial Analysis ... + Certified Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of… more
- Molina Healthcare (IA)
- …SIU an active relationship with third parties who have specific experience in conducting fraud and abuse investigations. * Prepares written reports to inform the ... 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… more
- Prime Therapeutics (Des Moines, IA)
- …**Job Description** Responsible for the intake and initial handling of allegations of fraud , waste or abuse . Conducts preliminary investigation to assess the ... audit or investigation. Serves as a corporate resource on fraud , waste and abuse issues and maintains...to find suspicious patterns and outliers using knowledge of healthcare coding conventions, fraud schemes, and general… more
- Molina Healthcare (Sioux City, IA)
- …day-to-day operations of the Compliance Program, Compliance Plan, Code of Conduct, and Fraud , Waste and Abuse Plan across the enterprise while ensuring ... for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- UnityPoint Health (Des Moines, IA)
- …for federally funded healthcare programs (eg Medicare and Medicaid) regarding fraud , waste and abuse . Brings any questions or concerns regarding compliance ... 168779 Overview This position is responsible for providing substance abuse evaluations, individual counseling, and group facilitation services to...recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in… more
- Elevance Health (Des Moines, IA)
- …responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse . **How you will make an impact:** + Examines ... relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control. +...next step in the claims lifecycle. + Researches new healthcare related questions as necessary to aid in investigations… more
- Cardinal Health (Des Moines, IA)
- …firm or in-house healthcare experience preferred, including commercial transactions and fraud and abuse compliance expertise + Experience working with Group ... to pharmaceutical distribution and services and group purchasing organizations, specifically AKS/ Fraud & Abuse + Identify opportunities for process improvements… more