- City of New York (New York, NY)
- …data analytics, data reporting, database hosting and systems used for fraud investigation, revenue collection activities and tracking. Ensure business continuity for ... program eligibility. Additionally, designing and operating analytics processes to identify Medicaid savings, both within DSS and State Department of Health (SDOH),… more
- CVS Health (IL)
- …internal teams prior to the submission to the Centers of Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, ... opportunities for providers, vendors and peers. + Expertise in medical documentation, fraud , abuse and penalties for documentation and coding violations based on… more
- MyFlorida (Tallahassee, FL)
- …Public Benefits Integrity (OPBI) is responsible for investigating government 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...months) experience determining eligibility for Cash, Food Assistance or Medicaid . + Must have one year (12 months) experience… more
- State of Colorado (Denver, CO)
- …is responsible for all applicable financial and medical benefits (eg Medicaid , Medicare, Social Security Insurance (SSI), Social Security Disability Insurance ... Processes: + Responsible for establishing relationships with community benefits agencies (eg Medicaid , SSA, etc.) and develops assigned contacts to utilize for the… more
- NTT America, Inc. (Plano, TX)
- …organization meets its HIPAA and healthcare-compliance-related obligations, including Medicare and Medicaid standards. This role will work closely with our Global ... and experience in assessing and operationalizing HIPAA, Medicare, and Medicaid requirements in a complex client-service environment. Key Responsibilities +… 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 Finance Office is requesting...areas such as IREA Claims and Collections, Bureau of Fraud Investigation and the Office of Liens and Trusts.… more
- State of Montana (Helena, MT)
- …The Compliance Specialist 2 is responsible for identifying and investigating potential fraud , waste, and abuse within Montana Medicaid and Healthy Montana ... healthcare policy, conducting provider interviews, calculating overpayments, and referring fraud cases to appropriate agencies. Additional responsibilities include educating… more
- Atlantic Health System (Morristown, NJ)
- …monitoring of regulatory developments, and legal research on regulatory issues, including fraud and abuse issues, HIPAA compliance, EMTALA, Medicare and Medicaid ... corporate work experience, including prior experience with hospitals, Medicare and Medicaid , and federal and state healthcare regulatory issues, including fraud… more
- SGI Global, LLC (Grand Rapids, MI)
- …the USAO's Affirmative Civil Enforcement program. Typical investigations involve: (1) monetary fraud against a multitude of federal programs or (2) civil violations ... Substances Act and various environmental laws. There is a special emphasis on fraud matters involving federal health care programs including Medicare and Medicaid… more
- City of New York (New York, NY)
- …makes programmatic and procedural recommendations to HRA programs to deter participant fraud . Office of Administrative Support (OAS) is the central repository for ... - Record and process manual and electronic checks received from Bureau of Fraud Investigation, Claims and Collections, Liens and Recovery and checks delivered to the… more