- MyFlorida (Miami, FL)
- …with a program integrity related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator; Certified ... an understanding about legal proceedings and investigations related to health care fraud and abuse . The Florida Medicaid program is one of the five largest in… more
- Highmark Health (Pittsburgh, PA)
- …a privacy professional within one year of employment **Preferred** + 3+ years experience with Fraud , Waste and Abuse + 3+ years Patient legal resolution + ... Healthcare research and resolution + Regulatory, Managed Care and Reimbursement **SKILLS** + Strong written and oral communication skills + Strong relationship building skills + Client focused with strong business acumen + Self-starter with the ability to… more
- Molina Healthcare (Syracuse, NY)
- …coordinating data extractions, gathering requirements, supporting payment integrity teams, primarily fraud , waste and abuse . + Experience working on SQL, ... PowerBI, databricks. + Experience on ETL , healthcare specifically claims is highly preferred. **JOB QUALIFICATIONS** **Required Education** Associate degree or… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and military experience will be considered. * Experience using data analysis tools (eg Healthcare Fraud Shield, etc.) * 1+ years staff, team lead or project ... performance feedback and encourage growth and development of staff. * Accredited Healthcare Fraud Investigator (AHFI) in good standing through the National… more
- Point32Health (Canton, MA)
- …Investigation Unit ("SIU") responsible for leading complex provider investigations related to fraud , waste, and abuse , and developing action plans to address ... prevent future loss. This role will be responsible for conducting high-volume Pre-Payment Fraud Waste & Abuse ("FWA") investigations under the direction of the… more
- Genesis Healthcare (PA)
- …of pertinent Federal and State Standards to reduce the company's vulnerability to fraud , abuse and waste audits; 8. Identifies providers not meeting applicable ... environment Posted Salary Range USD $75,000.00 - USD $75,000.00 /Yr. Genesis HealthCare , Inc. and all affiliated entities (collectively "Genesis") has a strong… 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
- Centene Corporation (Oklahoma City, OK)
- …perspective on workplace flexibility. **Position Purpose:** Develop, implement and manage strategic fraud , waste and abuse (FWA) activities by maintaining state ... compliance in billing and claims payment + Serve as a lead and investigate all possible fraud , waste and abuse referrals + Develop customized fraud plans to… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …activities throughout the school. + Oversee and have responsibility for the prevention of fraud , abuse , or financial conflict of interests within the school. + ... Communicates pertinent University-defined accounting structure, policies, procedures, and other financial developments to the school. Collaboration & Communication: + Collaborates with the Office of the Provost and with financial and operational colleagues… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …on the specific position **Required Training:** + HIPAA Privacy & Security Course + Fraud , Waste and Abuse Course **Job Skill Requirements:** + Business to ... business experience required + Superior communication skills, both verbal and written + Superior organizational skills + Ability to multi-task and prioritize + Coordinate and lead others in process improvement and change + Flexibility and ability to work under… more