- MVP Health Care (Rochester, NY)
- …Anti- Fraud investigation and reporting requirements including HIPAA, CMS, Medicare , Medicaid, and any corporate compliance initiatives or policies. + Minimal ... York State Nursing license required (RN preferred). Experience in health insurance fraud investigations preferred. + Obtain CPC and/or COC credential. + Maintain… more
- Molina Healthcare (Rochester, NY)
- …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
- 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
- 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
- CVS Health (Albany, NY)
- …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
- Amentum (Albany, NY)
- …entities, and assets. + Analyze large and complex healthcare claims datasets to identify fraud , waste, and abuse patterns. + Design and run SQL queries, models, and ... histories and flag suspicious activities for follow-up. + Evaluate allegations of fraud and provide recommendations to AUSAs for determination. + Based on … more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- …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 (Albany, NY)
- …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
- CVS Health (Albany, NY)
- …will support the Health Plan segment in all lines of business including Medicare Part D, Essential Plan, Qualified Health Plan (Exchange) and Child Health Insurance ... Plan and across Caremark Enterprise to identify improvement opportunities to reduce fraud , waste and abuse. -Work directly with Caremark and Health Plan leadership… more
- City of New York (New York, NY)
- …data analytics, data reporting, database hosting and systems used for fraud investigation, revenue collection activities and tracking. Ensure business continuity for ... spending. This work includes identifying Medicaid clients who should apply for Medicare , identifying Medicaid clients who should be part of buy-in program, and… more