- Elevance Health (Houston, TX)
- …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 (Houston, TX)
- …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 (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
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- …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 (Austin, TX)
- …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
- Zelis (Plano, TX)
- …claim data, with a focus on various pricing methodologies including Medicare , Medicaid, and commercial reimbursements. This role involves leveraging data to ... analysis, and reporting. + Understand claim payment methodologies such as Medicare , Medicaid, and Commercial Reimbursement. + Create visualizations and dashboards to… more
- Zelis (Plano, TX)
- …Medicaid billing, reimbursement, claim payment or cost reporting. + Experience with Medicare / Medicare Advantage or commercial billing and reimbursement a plus ... 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 (Austin, TX)
- …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
- Centene Corporation (Austin, TX)
- …and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of business, which includes implementation of elements of an effective ... 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