- Zelis (Plano, TX)
- …the personal interests that shape who you are. Position Overview The Sr. Medicaid Regulatory Pricer Analyst will collaborate with the Zelis Regulatory Pricer Product ... communicating rules, regulations, and procedures pertaining to public and private Medicaid payment systems. This position requires an in-depth knowledge of… more
- CVS Health (Austin, TX)
- …day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Dental/Pharmacy/Broker Investigative Team within Aetna's ... will manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct high level, complex… more
- CVS Health (Austin, TX)
- …the ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, ... education opportunities for peers. + Extensive knowledge of medical documentation, fraud , abuse and penalties for documentation and coding violations based on… more
- Zelis (Plano, TX)
- …claim data, with a focus on various pricing methodologies including Medicare, Medicaid , and commercial reimbursements. This role involves leveraging data to ensure ... and reporting. + Understand claim payment methodologies such as Medicare, Medicaid , and Commercial Reimbursement. + Create visualizations and dashboards to present… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- …and coding in rare disease + Strong knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, especially Medicare Part D + Experience in ... contacting Accommodation Request ([email protected]) . **Statement Regarding Job Recruiting Fraud Scams** At Otsuka we take security and protection of… more
- CVS Health (Austin, TX)
- …review findings. - Must be able to articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc. ... state and federal policies. - Identify potential billing errors, abuse, and fraud . - Identify opportunities for savings related to potential cases which may… more
- CVS Health (Austin, TX)
- …findings and ensure the team articulates findings effectively to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, and state ... state and federal policies, and identify potential billing errors, abuse, and fraud . + Identify opportunities for savings related to potential cases that may… more
- Centene Corporation (Austin, TX)
- …with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of business, which includes implementation of elements of ... industry generally, and government programs in the health sector specifically, including fraud and abuse and anti-kickback statutes, OIG and government health plan… 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 ... Conditions of Participation, physician/physician group contracting, Medical Staff/peer review matters, hospital/facility licensing, telemedicine, Ambulatory Surgical Centers, and other healthcare operations5. Excellent contract negotiation and drafting… more
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