- New York State Civil Service (Albany, NY)
- …Pearl St City Albany State NY Zip Code 12204 Duties Description The Division of Medicaid Investigations ensures the integrity of the Medicaid program by ... this endeavor using their expertise to conduct and oversee investigations of providers alleged of committing fraud ,...include but are not limited to:* Evaluating complaints of Medicaid fraud , waste and abuse and assigning… more
- New York State Civil Service (Albany, NY)
- …Pearl St City Albany State NY Zip Code 12204 Duties Description The Division of Medicaid Investigations ensures the integrity of the Medicaid program by ... this endeavor using their expertise to assist in the investigation of providers for potential fraud . Duties...are not limited to: * Investigating all allegations of Medicaid fraud , waste, and abuse. * Conducting… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …appropriate cases to governmental agencies (eg APS/CPS) as needed, and any suspected/possible Medicaid fraud to the Special Investigations Unit (SIU) or ... Departmental policies and ensures all regulatory requirements such as DOH, CMS, Medicaid , and accreditation requirements such as NCQA, URAC and HEDIS functionalities… more
- MVP Health Care (Schenectady, NY)
- …New York State Nursing license required (RN preferred). Experience in health insurance fraud investigations preferred. + Obtain CPC and/or COC credential. + ... training of new SIU personnel. + Keep abreast of Federal and State Anti- Fraud investigation and reporting requirements including HIPAA, CMS, Medicare, … more
- City of New York (New York, NY)
- …DSS complies with all statutory, regulatory, and contractual standards. The Bureau of Fraud Investigations (BFI) is mandated to conduct investigations of ... against the social service programs administered by HRA/DSS. The Medicaid Investigations Division (MID) is mandated to...Division (MID) is mandated to provide expanded levels of fraud detection, investigation and prevention to the… more
- City of New York (New York, NY)
- …as a Group Supervisor, who will: - Oversee two investigative units engaged in Medicaid (MA) case reviews and investigations for the purpose of revenue recovery ... Job Description APPLICANTS MUST BE PERMANENT IN THE ASSOCIATE FRAUD INVESTIGATOR CIVIL SERVICE TITLE. The DSS Accountability Office (DSS-AO) is responsible for… more
- CVS Health (Albany, NY)
- …Manager will oversee a team of medical coders within the Special Investigations Unit (SIU) to ensure compliance with coding practices through comprehensive record ... findings and ensure the team articulates findings effectively to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, and state… more
- CVS Health (Albany, NY)
- …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 ...federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud . +… more
- City of New York (New York, NY)
- Job Description APPLICANTS MUST BE PERMANENT IN THE FRAUD INVESTIGATOR CIVIL SERVICE TITLE The DSS Accountability Office (DSS-AO) is responsible for protecting the ... It is also responsible for evaluating and assessing the resources of Medicaid Nursing Home residents through computer bank matches, assessing the income and… 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