- Zelis (Plano, TX)
- …claim data, with a focus on various pricing methodologies including Medicare, Medicaid , and commercial reimbursements. This role involves leveraging data to ensure ... and reporting. + Understand claim payment methodologies such as Medicare, Medicaid , and Commercial Reimbursement. + Create visualizations and dashboards to present… more
- MyFlorida (Wildwood, FL)
- …of 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...process and procedures for the Cash, Food Assistance, and Medicaid programs, and have expertise in the use of… more
- Elevance Health (Mason, OH)
- …the identification, investigation and development of cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on fraudulent ... Medicaid claims. **How You Will Make an Impact:** +...background. **Preferred Qualifications:** + Healthcare experience strongly preferred + Fraud certification from CFE, AHFI, AAPC or coding certificates… more
- MVP Health Care (Rochester, NY)
- …York State Nursing license required (RN preferred). Experience in health insurance fraud investigations preferred. + Obtain CPC and/or COC credential. + Maintain ... training of new SIU personnel. + Keep abreast of Federal and State Anti- Fraud investigation and reporting requirements including HIPAA, CMS, Medicare, Medicaid ,… more
- Philips (Malvern, PA)
- …the seven elements of an effective compliance program to detect and prevent fraud , waste and abuse. **Your role:** + Develop, implement, and maintain policies and ... federal healthcare program requirements, independent diagnostic testing facility regulations, and fraud and abuse laws, including the Anti-Kickback Statute and the… more
- CVS Health (CT)
- …working with Medicaid and Medicare programs - Familiarity with state-specific fraud investigation protocols (eg, Texas OIG, Florida AHCA) - Prior experience in a ... within the Special Investigations Unit (SIU) plays a key role in supporting fraud , waste, and abuse investigations by managing and responding to Requests for… more
- First Atlantic Health Care (Saco, ME)
- …Healthcare, part of the Atlantic Heights Community, is a fully-licensed Medicaid /Medicare-certified facility offering 105 beds. Our Maintenance Team at Seal Rock ... facilities when necessary. + Provide information to resident/families as to Medicare/ Medicaid , and other financial assistance programs available to the resident. +… more
- Blue KC (KS)
- …limited to Sales and Marketing, Job_Family_ID_Underwriting, PHP, Special investigations Unit ( fraud and abuse), Legal, Product Development, and Provider Services. + ... of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical management organizations, hospitals/… more
- CVS Health (IN)
- …the ICD-10 codes that are submitted to the Centers for 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
- Baylor Scott & White Health (Dallas, TX)
- …standards, such as the Joint Commission, Centers for Medicare and Medicaid (CMS), National Committee for Quality Assurance (NCQA), Health Insurance Portability ... Commission (HHSC), Office of Inspector General (OIG), the Centers for Medicare and Medicaid Services (CMS), and the Texas Department of Insurance (TDI). - Manages… more