- Centene Corporation (Frankfort, KY)
- …must reside within the state of Kentucky. **Position Purpose:** Investigate allegations of healthcare fraud and abuse activity. Assist in planning, ... investigations or audits that identify, evaluate and measure potential healthcare fraud . + Assist in monitoring business...billing and claims payment + Investigate possible waste , abuse and fraud leads and document activity… more
- Elevance Health (Louisville, KY)
- …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
- Humana (Frankfort, KY)
- …yrs health insurance claims or Medicare experience + Minimum 3 years of experience with Fraud , Waste, and Abuse in either a Managed Care or a government setting ... investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste works within specific guidelines and procedures; applies advanced… more
- Molina Healthcare (Covington, KY)
- …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
- Highmark Health (Frankfort, KY)
- …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 (Lexington, KY)
- …and actions. + Works with leadership to maintain and revise policies and procedures, fraud , waste, and abuse plans, annual audit work plans, including department ... License, Certification, Association + Active and unrestricted Accredited Health Care Fraud Investigator (AHFI) designation or Certified Fraud Examiner (CFE)… more
- Molina Healthcare (Bowling Green, KY)
- …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 (Frankfort, KY)
- …**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 (Owensboro, KY)
- …standards and requirements contained in the Molina Medical Compliance and Fraud , Waste and Abuse Program. **KNOWLEDGE/SKILLS/ABILITIES** + Coordinates, conducts, ... for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- Cardinal Health (Frankfort, KY)
- …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