- Molina Healthcare (Houston, TX)
- …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 (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 ... for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- Prime Healthcare (Dallas, TX)
- Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360 ... nearly 57,000 employees and physicians. Eighteen of the Prime Healthcare hospitals are members of the Prime Healthcare...the Antikickback Statute, the False Claims Act, and other Fraud , Waste and Abuse laws and regulations, along with… more
- CVS Health (Austin, TX)
- …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
- Elevance Health (Grand Prairie, TX)
- …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. (Austin, TX)
- …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
- Zelis (Plano, TX)
- … healthcare insurance industry required . + Strong knowledge of Medicare pricing, reimbursement practices, and healthcare claims processing. + Demonstrated ... 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
- Abbott (Austin, TX)
- …demands of rapidly changing environment. A solid understanding of the Medicaid laws, Medicaid/ Medicare + Fraud & Abuse statutes, Anti-Trust Laws, and Abbott's ... Abbott is a global healthcare leader that helps people live more fully...long-term business growth. + Ensure strict compliance with Medicaid, Medicare , and other relevant regulatory programs, and provide guidance… more
- Highmark Health (Austin, TX)
- …+ 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
- Elara Caring (Dallas, TX)
- …OASIS Specialist-Clinical (COS-C) is preferred + Understanding of Federal and State healthcare laws and regulations pertaining to fraud , waste and abuse ... our mission every day. Join our elite team of healthcare professionals, providing the Right Care, at the Right...(PCS) agencies at Elara Caring to ensure compliance with Medicare and Medicaid regulations and billing rules. Areas of… more