- Molina Healthcare (Columbus, OH)
- …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
- KPH Healthcare Services, Inc. (Maumee, OH)
- …the specific position **Required Training:** + HIPAA Privacy & Security Course + Fraud , Waste, and Abuse Course **Job Skills Required:** + Communicates ... effectively with patients, families and other health care providers + Manages time efficiently and + Thinks and acts calmly and logically to meet unusual occurrences of the job + Maintains confidentiality of necessary + Interfaces with patients, families, and… more
- Highmark Health (Columbus, OH)
- …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 (Columbus, OH)
- …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
- CVS Health (Columbus, OH)
- …3-5 years. + Strong analytical and investigative skills, with experience in healthcare fraud detection. + Proficiency in interpreting claims data, medical ... plays a pivotal role in safeguarding the organization against fraud , waste, abuse (FWA), and compliance violations. This position is embedded within… more
- Elara Caring (Toledo, OH)
- …of Federal and State healthcare laws and regulations pertaining to fraud , waste and abuse prevention and patient privacy rights and protections. ... our mission every day. Join our elite team of healthcare professionals, providing the Right Care, at the Right...calling: developing an amazing team of compassionate and dedicated healthcare providers. To continue to be an industry pioneer… more
- Cardinal Health (Columbus, OH)
- …firm or in-house healthcare experience preferred, including commercial transactions and fraud & abuse compliance expertise + Experience working with GPO's, ... and contract manufacturing. **_Responsibilities_** + Demonstrate knowledge of commercial healthcare law, including pharmaceutical distribution and manufacturing + Demonstrate… more
- Walgreens (Canal Winchester, OH)
- …with policies andprocedures (eg, HIPAA guidelines/regulations, insurance, and fraud abuse guidelines, requiredproductivity levels, timeliness expectations, ... Puerto Rico. Walgreens has approximately 220,000 team members, including nearly 90,000 healthcare service providers, and is committed to being the first choice for… more
- CVS Health (Columbus, OH)
- …to coding questions, state and federal policies. + Identify potential billing errors, abuse , and fraud . + Identify opportunities for savings related to potential ... through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. The CPC must have the ability to determine correct… more
- CVS Health (Columbus, OH)
- …to coding questions, state and federal policies. - Identify potential billing errors, abuse , and fraud . - Identify opportunities for savings related to potential ... through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. The CPC must have the ability to determine correct… more