- Molina Healthcare (Tampa, FL)
- …reporting, and when appropriate, recovery of money related to health care fraud , waste, and abuse. Duties include performing accurate and reliable medical review ... Counsel, and Medical Officers in order to achieve and maintain appropriate anti- fraud oversight. **Job Duties** + Responsible for developing leads presented to the… more
- Humana (Tallahassee, FL)
- …* A minimum of 2 years' experience conducting comprehensive health care fraud investigations (Medical Coding or Healthcare (Medical Chart Review/Insurance ... part of our caring community and help us put health first** The Fraud and Waste Professional 2 is responsible for conducting comprehensive investigations of… 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 ... for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- CVS Health (Tallahassee, FL)
- …investigators and analysts to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to ... the planning and execution of investigations of acts of healthcare fraud and abuse by both members... Program Integrity, Medicaid Special Investigation or Medicaid / Medicare / Commercial Compliance role + Strong verbal and… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …therapeutic areas. This role operates as a crucial liaison between healthcare providers (HCPs), internal teams, and external stakeholders to facilitate appropriate ... requirements + Analyze payer criteria and provide product access expertise to healthcare offices + Coordinate with Hubs on individual patient cases, including… more
- AssistRx (Orlando, FL)
- …Knowledge of regulatory requirements affecting pharmacy and medical copay programs, including healthcare compliance and fraud prevention. + . Ability to analyze ... comply with all federal, state, and industry regulations, including anti-kickback statutes, Medicare /Medicaid rules, FDA and OIG guidance. + Work closely with the… more
- Zelis (St. Petersburg, FL)
- …of revenue opportunities + Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs + Strong understanding of ... So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more… more
- Highmark Health (Tallahassee, FL)
- …+ Certified Public Accountant (CPA) + Certified Internal Auditor (CIA) + Certified Fraud Examiner (CFE) + Certified in Healthcare Compliance (CHC) + Certified ... related field **EXPERIENCE** **Required** + 7 years in compliance, privacy, government affairs, healthcare operations, risk, audit, or legal functions + 5 years in a… more