- Elevance Health (FL)
- …preferred. + Project management certification preferred. + Marketing experience preferred. + Medicare Part D experience preferred. + Fraud waste and abuse ... experience preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $94,416 -$161,856 Locations: California, District of Columbia (Washington, DC), Illinois, Maryland, New York In… more
- Molina Healthcare (Tampa, FL)
- …operations of the Compliance Program, Compliance Plan, Code of Conduct, and Fraud , Waste and Abuse Plan across the enterprise while ensuring compliance with ... governmental requirements. * Spearheads development and implementation of compliance policies and procedures and training programs for the Molina enterprise. * Oversees and provides direction of site visits for regulatory audits and coordinates corrective… more
- CVS Health (Tallahassee, FL)
- …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
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …access, billing, and coding in rare disease + Strong knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, especially Medicare Part ... contacting Accommodation Request ([email protected]) . **Statement Regarding Job Recruiting Fraud Scams** At Otsuka we take security and protection of… more
- CVS Health (Tallahassee, FL)
- …applicable) to ensure the ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are ... education opportunities for peers. + Extensive knowledge of medical documentation, fraud , abuse and penalties for documentation and coding violations based on… more
- AssistRx (Orlando, FL)
- …comply with all federal, state, and industry regulations, including anti-kickback statutes, Medicare /Medicaid rules, FDA and OIG guidance. + Work closely with the ... with pharmaceutical manufacturers and understanding of third-party payer systems (commercial, Medicare , Medicaid). Skills & Competencies: + . Strong leadership and… more
- Zelis (St. Petersburg, FL)
- …revenue opportunities + Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs + Strong understanding of hospital ... We do not use WhatsApp or personal emails for recruitment. Forward any suspected fraud to ###@zelis.com for prompt investigation. Thank you for staying vigilant. more
- Highmark Health (Tallahassee, FL)
- …Certified Public Accountant (CPA) + Certified Internal Auditor (CIA) + Certified Fraud Examiner (CFE) + Certified in Healthcare Compliance (CHC) + Certified ... and cross-functional strategy development. + Experience with managed care, Medicare and federal and/or state regulations, quality improvement and compliance… more