- Molina Healthcare (Columbus, 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
- Molina Healthcare (Columbus, OH)
- …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
- Grant Thornton (Cleveland, OH)
- …for business and IT process optimization, profit improvement, cost reduction, fraud prevention, internal control, and compliance. + Perform engagement management ... 4 years of direct experience with diverse life sciences companies or healthcare providers, including hospitals, academic medical centers, healthcare systems, and… more
- CVS Health (Columbus, OH)
- …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
- 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
- Elevance Health (Mason, OH)
- …for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. **How you will make an impact:** + Examines claims for ... compliance with relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control. + Reviews and conducts analysis… more
- Otsuka America Pharmaceutical Inc. (Columbus, OH)
- …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
- Highmark Health (Columbus, OH)
- …+ 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