- Centene Corporation (Indianapolis, IN)
- …to program integrity and disclosure requirements. Develop, implement and manage strategic fraud , waste and abuse activities by maintaining state and federal ... to our Indiana Medicaid product lines. + Safeguard against the potential for fraud , waste and abuse and coordinate with, the Special Investigations Unit… more
- ICF (St. Paul, MN)
- …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
- 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 ... Overview Prime Healthcare is an award-winning health system headquartered in...an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360… more
- Molina Healthcare (Columbus, OH)
- …SIU an active relationship with third parties who have specific experience in conducting fraud and abuse investigations. * Prepares written reports to inform the ... Enforces, as a representative of management, the Compliance Plan, Code of Conduct and Anti- Fraud Plan. * Establishes, at the direction of the AVP of Compliance or… more
- Zelis (St. Petersburg, FL)
- …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 ... top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across… more
- Molina Healthcare (Sioux City, IA)
- …standards and requirements contained in the Molina Medical Compliance and Fraud , Waste and Abuse Program. **KNOWLEDGE/SKILLS/ABILITIES** + Coordinates, conducts, ... for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- CVS Health (Sacramento, CA)
- …healthcare integrity and protect patient well-being. As the Medical Director of Healthcare Fraud Investigations, you'll lead our efforts to detect, prevent, ... for performing reviews of medical records in support of healthcare fraud investigations. Serving as a clinical...resources and technology in developing evidence, supporting allegations of fraud , waste, or abuse + Documents all… more
- CVS Health (Phoenix, AZ)
- …to the investigation of suspected healthcare fraud cases Completion of Fraud waste and abuse reviews in partnership with SIU. + Providers SME support ... Service Operations, this position will focus on utilization, quality and fraud waste and abuse review for individual cases for members across Aetna . This… more
- KPH Healthcare Services, Inc. (Maumee, OH)
- …the specific position **Required Training:** + HIPAA Privacy & Security Course + Fraud , Waste, and Abuse Course **Job Skills Required:** + Communicates ... effectively with patients, families and other health care providers + Manages time efficiently and + Thinks and acts calmly and logically to meet unusual occurrences of the job + Maintains confidentiality of necessary + Interfaces with patients, families, and… more
- Elevance Health (Hanover, MD)
- …errors. Works with health plan leaders, oversees the monitoring and enforcement of the fraud , waste, and abuse compliance program to prevent and detect potential ... fraud , waste, and abuse activities pursuant to state and federal rules and...Requires a BA/BS in business, engineering, nursing, finance, or healthcare administration and minimum of 5 years related work… more