- Molina Healthcare (Louisville, KY)
- …The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position ... of experience working in a FWA / SIU or Fraud investigations + Thorough knowledge of PC based software...position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina… more
- CVS Health (Frankfort, KY)
- …communication skills + Advanced experience in Excel **Preferred Qualifications** + Experience in healthcare fraud , waste and abuse + Knowledge of Medicaid ... skills in SQL and Python who can transform complex healthcare data into actionable insights to support fraud , waste, and abuse (FWA) detection and Medicaid… more
- CVS Health (Frankfort, KY)
- …this role, you will manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + ... Conduct high level, complex investigations of known or suspected acts of healthcare fraud , waste and abuse . + Conduct Investigations to prevent payment of… more
- Molina Healthcare (Bowling Green, 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
- Molina Healthcare (KY)
- …insurance company + Minimum of two (2) years' experience working on healthcare fraud related investigations/reviews + Proven investigatory skill; ability to ... The position must have the ability to determine correct coding, documentation, potential fraud , abuse , and over utilization by providers and recipients. The… more
- Molina Healthcare (Louisville, 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 (Lexington, KY)
- …Areas of exposure may include: + Economics/Finance + Data Analysis / Science + Fraud , Waste, and Abuse (FWA) + Other data intensive areas **Preferred ... **JOB DESCRIPTION** **Job Summary** The Molina Healthcare Internship Program shares an objective to create...aim to be professionals and future leaders in the healthcare business profession. Interns are assigned special projects and… more
- Molina Healthcare (KY)
- …coordinating data extractions, gathering requirements, supporting payment integrity teams, primarily fraud , waste and abuse . + Experience working on SQL, ... PowerBI, databricks. + Experience on ETL , healthcare specifically claims is highly preferred. **JOB QUALIFICATIONS** **Required Education** Associate degree or… more
- Highmark Health (Frankfort, KY)
- …Analytics will work closely with Senior Data Scientists to support Highmark's Fraud , Waste, and Abuse identification efforts. Daily responsibilities will involve ... the in-depth analysis of complex healthcare claims data utilizing advanced analytical techniques to detect...the business. - Collaborate with senior team members on Fraud , Waste, and Abuse identification initiatives to… more
- CVS Health (Frankfort, KY)
- …self-funded plan sponsor. The lead reviewer is accountable for the validation of existing fraud waste and abuse business rules and leads designed to detect ... Aetna business. + Keep current with new and emerging fraud , waste, and abuse schemes and trends...3-5 years of data interpretation and analysis experience. + Healthcare background. + Experience with internal claims data and… more