- CVS Health (Austin, TX)
- …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
- Danaher Corporation (Austin, TX)
- … industry + Drafting, reviewing, and negotiating various types of agreements + US healthcare fraud and abuse laws, rules, regulations, regulatory guidance, ... various legal issues and associated risks, including transactions with healthcare providers, research institutions, and promotional programs. + Provide… more
- Elevance Health (Houston, TX)
- …preferred. + Marketing experience preferred. + Medicare Part D experience preferred. + Fraud waste and abuse experience preferred. For candidates working in ... dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with...Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of… more
- Elevance Health (Grand Prairie, TX)
- …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
- Danaher Corporation (Austin, TX)
- …would be a plus if you also possess previous experience in: + Experience with healthcare regulation, including: fraud and abuse (eg, anti-kickback); FDA for ... we've been dedicated to advancing and optimizing the laboratory to move science and healthcare forward. Join a team where you can be heard, be supported, and always… more
- Highmark Health (Austin, TX)
- …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
- Centene Corporation (Austin, TX)
- …years project implementation, product or program management experience. 5+ years in Healthcare Fraud Investigation highly preferred. Experience in developing ... SIU Program Manager role will support the organizations efforts to detect and prevent fraud and abuse by supporting the partnership with our analytics team by… more
- Molina Healthcare (Houston, TX)
- …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 Healthcare (Dallas, TX)
- …to the Stark Law, the Antikickback Statute, the False Claims Act, and other Fraud , Waste and Abuse laws and regulations, along with the Medicare/Medicaid ... Overview Prime Healthcare is an award-winning health system headquartered in...an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360… more
- Prime Therapeutics (Austin, TX)
- …**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
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