- CVS Health (Columbus, OH)
- …you will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse . Routinely handles cases that are sensitive ... state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse matters. + Demonstrates high level of knowledge… more
- Molina Healthcare (OH)
- …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 (Columbus, OH)
- …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
- Centene Corporation (Columbus, OH)
- …state of Ohio are highly preferred.** **Position Purpose:** Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, ... claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse . + Conduct investigations of potential waste,… more
- AmeriHealth Caritas (Columbus, OH)
- …+ An associate's degree, with a minimum of four years of experience working in healthcare fraud , waste, and abuse investigations and audits. + Experience and ... with all requirements related to Special Investigation Units and fraud , waste and abuse investigations. + Conducts...experience in the healthcare field working in fraud , waste, and abuse investigations and audits… more
- CVS Health (Columbus, OH)
- …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
- Humana (Dayton, OH)
- …**Required Qualifications** + Must reside in Ohio + At least 2 years of healthcare fraud investigations and auditing experience + Knowledge of healthcare ... Humana's Program Integrity Officer, who will oversee the monitoring and enforcement of the fraud , waste, and abuse (FWA) compliance program to prevent and detect… more
- Molina Healthcare (Cincinnati, OH)
- …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
- KPH Healthcare Services, Inc. (Maumee, OH)
- …drug screening test **Required Training:** + HIPPA Privacy Course + HIPPA Security Course + Fraud , Waste, and Abuse Course + MethGuard Course + HIPPA Privacy CE ... procedures. + Communicates appropriately with all members of the healthcare team. + Documents appropriately according to AristaCare P&Ps,...Mastery Exam + HIPPA Security CE Mastery Exam + Fraud , Waste, and Abuse CE Mastery Exam… more
- Molina Healthcare (Dayton, OH)
- …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