- Molina Healthcare (Dayton, OH)
- …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
- Bon Secours Mercy Health (Cincinnati, OH)
- …protocols specific to hospital revenue cycle risk areas highlighted by the OIG, Medicare , State Medicaid, State Insurance Fraud ; Managed Care or Governmental ... for the development of compliance internal monitors and audit protocols and the prevention of fraud , waste and abuse. + Develops compliance monitors and audit… more
- ICF (Columbus, OH)
- … data systems, Medicare and Medicaid claims, and the government's healthcare fraud , waste, and abuse workflow. Job Location- Primarily remote within ... , waste, and abuse, and in support of ongoing healthcare fraud investigations by internal staff and...degree in a related field. + Demonstrated knowledge of healthcare claims data, including Medicare and Medicaid.… more
- ICF (Columbus, OH)
- …programs.. + Experience with the CMS fraud workflow and processes for healthcare fraud investigations, such as contractors for the Center for Program ... health agency. Under this program, ICF will investigate potential fraud , waste, and abuse in Medicare and...legal integrity of operations. + Maintain up-to-date knowledge of healthcare law and policy changes. **Basic Qualifications:** + Must… more
- ICF (Columbus, OH)
- …Medicaid programs. + At least 2+ years of experiencein estimating overpayments for healthcare fraud investigations. + Eligible to complete the HHS background ... health agency. Under this program, ICF will investigate potential fraud , waste, and abuse in Medicare and...the CMS fraud workflow and processes for healthcare fraud investigations, such as contractors for… more
- ICF (Columbus, OH)
- …Trust clearance. Preferred Qualifications: + Intensive experience conducting and overseeing healthcare fraud investigations for healthcare payers and/or ... health agency. Under this program, ICF will investigate potential fraud , waste, and abuse in Medicare and...waste, and abuse workflow + Credentials such as: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud… more
- Humana (Columbus, OH)
- …ensures adherence to policies, procedures, and regulations and to prevent and detect fraud , waste, and abuse to ensure appropriate course of action. The Quality ... the ability to travel as needed is necessary. **Preferred Qualifications** + Licensed healthcare professional in the state of Michigan: LPN, RN, LSW, LISW. +… more