- New York State Civil Service (Albany, NY)
- …of the position include but are not limited to:* Evaluating complaints of Medicaid fraud , waste and abuse and assigning complaints for investigation.* Conducting ... NY HELP No Agency Medicaid Inspector General, NYS Office of the Title...conduct and oversee investigations of providers alleged of committing fraud , waste, and abuse. The official workstation of this… more
- New York State Civil Service (Albany, NY)
- …will include, but are not limited to: * Investigating all allegations of Medicaid fraud , waste, and abuse. * Conducting fieldwork, including surveillance and ... NY HELP No Agency Medicaid Inspector General, NYS Office of the Title...NY Zip Code 12204 Duties Description The Division of Medicaid Investigations ensures the integrity of the Medicaid… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …cases to governmental agencies (eg APS/CPS) as needed, and any suspected/possible Medicaid fraud to the Special Investigations Unit (SIU) or designated ... Departmental policies and ensures all regulatory requirements such as DOH, CMS, Medicaid , and accreditation requirements such as NCQA, URAC and HEDIS functionalities… more
- New York State Civil Service (New York, NY)
- …Criminal Enforcement and Financial Crimes Bureau, the Organized Crime Task Force, and the Medicaid Fraud Control Unit, and must be provided an opportunity to ... intervene in any case in which the constitutionality of a state criminal statute is challenged.The bureau also responds to federal habeas corpus petitions bringing constitutional challenges to state court convictions obtained by district attorneys throughout… more
- City of New York (New York, NY)
- …for NYS Medicaid . SOS 366-a(2)(a). MID review cases identified as susceptible to fraud and examine Medicaid enrollee documents found in the HRA One Viewer ... Job Description APPLICANTS MUST BE PERMANENT IN THE FRAUD INVESTIGATOR CIVIL SERVICE TITLE OR IN A...against the social service programs administered by HRA/DSS. The Medicaid Investigations Division (MID) is mandated to provide expanded… more
- Guthrie (Corning, NY)
- …verify, licensure/registration and standing, Queries the National Practitioner Data Bank and Medicare/ Medicaid site for fraud and abuse and ECFMG verification, ... Sends reference request letters to all listed references and past hospital affiliation, Reviews completed application with Medical Director and Chief of Service. Advises applicants of final appointment decision and informs appropriate departments relative to… more
- City of New York (New York, NY)
- Job Description APPLICANTS MUST BE PERMANENT IN THE ASSOCIATE FRAUD INVESTIGATOR CIVIL SERVICE TITLE. The DSS Accountability Office (DSS-AO) is responsible for ... It is also responsible for evaluating and assessing the resources of Medicaid Nursing Home residents through computer bank matches. Claims and Collections also… more
- MVP Health Care (Tarrytown, NY)
- …York State Nursing license required (RN preferred). Experience in health insurance fraud investigations preferred. + Obtain CPC and/or COC credential. + Maintain ... training of new SIU personnel. + Keep abreast of Federal and State Anti- Fraud investigation and reporting requirements including HIPAA, CMS, Medicare, Medicaid ,… more
- City of New York (New York, NY)
- Job Description The Medical Assistance Program (MAP) administers Medicaid and related public health insurance programs, for the City of New York. Applying ... Managed Care Organizations (MCOs) and case management providers through which eligible Medicaid clients access behavioral and health care services. MCP is comprised… more
- MVP Health Care (Schenectady, NY)
- …role safeguards financial integrity, strengthens provider trust, and drives innovation in fraud prevention and cost containment. **What's in it for you:** + Growth ... to address emerging trends such as value-based care, regulatory shifts, and fraud schemes. **Operational Excellence & Process Improvement** + Champion Lean and Six… more