- Molina Healthcare (Dallas, TX)
- …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
- Molina Healthcare (Houston, TX)
- …day-to-day operations of the Compliance Program, Compliance Plan, Code of Conduct, and Fraud , Waste and Abuse Plan across the enterprise while ensuring ... for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- CVS Health (Austin, TX)
- …to the investigation of suspected healthcare fraud cases. Completion of Fraud waste and abuse reviews in partnership with SIU + Provide SME support ... position will focus on utilization, quality, and review of fraud , waste, and abuse for individual Aetna...quality, and review of fraud , waste, and abuse for individual Aetna member cases. **Expectations/Responsibilities:** + Review… more
- CVS Health (Austin, TX)
- …extraction and analysis. The lead reviewer is accountable for the validation of existing Fraud Waste and Abuse Business Rules and leads designed to detect ... warranted. **Fundamental Components:** -Research and ad hoc report development to identify fraud , waste, and abuse schemes and trends. -Review company clinical… more
- Elevance Health (Houston, TX)
- …responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse . **How you will make an Impact:** + Examines ... relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control. +...next step in the claims lifecycle. + Researches new healthcare related questions as necessary to aid in investigations… more
- Elevance Health (Grand Prairie, TX)
- …responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse . **How you will make an impact:** + Examines ... relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control. +...next step in the claims lifecycle. + Researches new healthcare related questions as necessary to aid in investigations… more
- Cardinal Health (Austin, TX)
- …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
- Experian (Allen, TX)
- …around the world. We help to redefine lending practices, uncover and prevent fraud , simplify healthcare , create marketing solutions, and gain deeper insights ... into cyber incidents, data breaches, malware infections, unauthorized access, insider threats, fraud and abuse , and employee misconduct. + Analyze digital… more
- Texas Health Resources (Arlington, TX)
- …in areas vulnerable to error or noncompliance such as billing, coding, Stark laws, fraud & abuse laws, false claims, or other identified risk areas. Participate ... needed. 0% What You Need: **Education** Master's Degree Master?s degree in healthcare , business, or another applicable field. Req **Experience** 5 Years Minimum of… more
- Cardinal Health (Austin, TX)
- …patients and prescribers and by federal and state government programs, for example, fraud and abuse (Anti-Kickback Statute, False Claims Act, Civil Monetary ... Health is seeking a driven and skilled attorney with expertise in healthcare regulatory compliance, including third party billing and reimbursement. The Assistant… more