- Molina Healthcare (Nampa, ID)
- …reporting, and when appropriate, recovery of money related to health care fraud , waste, and abuse. Duties include performing accurate and reliable medical review ... Medical Officers in order to achieve and maintain appropriate anti- fraud oversight. **Job Duties** + Responsible for developing leads... investigations. + Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. +… more
- CVS Health (NC)
- …Python who can transform complex healthcare data into actionable insights to support fraud , waste, and abuse (FWA) detection and Medicaid regulatory & compliance ... maintain complex data analyses to support investigations of potential fraud , waste, and abuse in Medicaid claims...of potential fraud , waste, and abuse in Medicaid claims and provider activity. + Prepare timely and… more
- University of Rochester (Brighton, NY)
- …assisted living communities. This includes, but is not limited to fraud and abuse, billing compliance, corporate transactions, physician employment and compensation, ... for Health Sciences, researches, analyzes, and provides regulatory compliance advice on the Fraud and Abuse + Laws, including, but not limited to, the Anti-Kickback… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …this position is responsible for the accurate and thorough clinical investigation of potential fraud , waste and abuse (FWA) for all lines of business. The scope of ... + Prepares recommendations on preventive/corrective measures for the deterrent of future fraud . + Supports other SIU investigators and analysts with their cases by… more
- MyFlorida (Orlando, FL)
- …of Public Benefits Integrity (OPBI) is responsible for investigating public assistance fraud or misuse regarding the SNAP (Food Assistance), D-SNAP (Disaster Food ... Assistance), TANF (Cash Assistance), and Medicaid programs by individuals or merchants. TO BE CONSIDERED...investigates referrals for potential overpayment(s) as a result of fraud , inadvertent household error or agency error. + Analyzes… more
- Centene Corporation (Indianapolis, IN)
- …program integrity and disclosure requirements. Develop, implement and manage strategic fraud , waste and abuse activities by maintaining state and federal ... monitoring trends and schemes. + Dedicated to our Indiana Medicaid product lines. + Safeguard against the potential for... product lines. + Safeguard against the potential for fraud , waste and abuse and coordinate with, the Special… more
- City of New York (New York, NY)
- …from the Social Security Administration for SN/SSI clients and SSP refunds and Medicaid Spend Down program payments. DARB is responsible for the collections, refunds ... of these payments being extremely time sensitive and trigger Medicaid coverage for customers. The Office of Fiscal Operations...as IREA Claims & Collections and the Bureau of Fraud and Investigation, submit payments received from customers for… more
- City of New York (New York, NY)
- …in reducing fraud . Ensure staff perform quality assurance on EMEDNY, Medicaid Data Warehouse (MDW), Enterprise Data Warehouse (EDW) MA queries, and WMS look-ups. ... potential errors by reviewing records of Cash Assistance and Medicaid Assistance Program (MAP) cases and analyzing their contents...III to function as the Unit Supervisor in the Medicaid Data Analysis Unit who will: Supervise and guide… more
- University of Rochester (Rochester, NY)
- …and staff, covering essential topics such as coding, compliance with Medicare, Medicaid , and third-party payer billing regulations, and fraud , waste, and ... risk assessments, and regulatory monitoring to prevent and detect fraud , waste, and abuse, specifically addressing the DRA, NY...requirements as defined by AMA, AHA, HCPCS, CMS, and Medicaid guidelines. + Creates and provides reports on findings… more
- Option Care Health (Bannockburn, IL)
- …risk areas such as regulatory changes, billing and coding, privacy and security, and fraud and abuse. + Perform data analysis and review of documentation to identify ... compliance requirements related to billing and coding, privacy and security, and fraud , waste and abuse, including but not limited to HIPAA, Anti-Kickback, Stark,… more