- Humana (Oklahoma City, OK)
- …**Required Qualifications** + **Must be an Oklahoma resident** + 2+ years of healthcare fraud investigations and auditing experience + Knowledge of healthcare ... help us put health first** Humana's Special Investigations Unit is seeking a Senior Fraud & Waste Investigator to join the Oklahoma Medicaid Team. This team of… more
- Executive Office for US Attorneys and the Office of the US… (Denver, CO)
- …and analytical work to support the criminal litigation needs of Health Care Fraud (HCF) investigations and trials for the United States Attorney's Office. Typical ... work assignments will include: Providing technical litigation support to Health Care Fraud (HCF) criminal trial teams in order to facilitate litigation decisions,… more
- 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 ... Counsel, and Medical Officers in order to achieve and maintain appropriate anti- fraud oversight. **Job Duties** + Responsible for developing leads presented to the… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …protocols specific to hospital revenue cycle risk areas highlighted by the OIG, Medicare , State Medicaid, State Insurance Fraud ; Managed Care or Governmental ... for the development of compliance internal monitors and audit protocols and the prevention of fraud , waste and abuse. + Develops compliance monitors and audit… more
- Zelis (Plano, TX)
- …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
- ICF (Baltimore, MD)
- … data systems, Medicare and Medicaid claims, and the government's healthcare fraud , waste, and abuse workflow. Job Location- Primarily remote within ... , waste, and abuse, and in support of ongoing healthcare fraud investigations by internal staff and...degree in a related field. + Demonstrated knowledge of healthcare claims data, including Medicare and Medicaid.… more
- ICF (Columbus, OH)
- …programs.. + Experience with the CMS fraud workflow and processes for healthcare fraud investigations, such as contractors for the Center for Program ... health agency. Under this program, ICF will investigate potential fraud , waste, and abuse in Medicare and...legal integrity of operations. + Maintain up-to-date knowledge of healthcare law and policy changes. **Basic Qualifications:** + Must… more
- Prime Healthcare (Dallas, TX)
- Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360 ... nearly 57,000 employees and physicians. Eighteen of the Prime Healthcare hospitals are members of the Prime Healthcare...the Antikickback Statute, the False Claims Act, and other Fraud , Waste and Abuse laws and regulations, along with… more
- CVS Health (WV)
- …you will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high ... involving multi-lines of business, or cases involving multiple perpetrators or intricate healthcare fraud schemes. + Investigates to prevent payment of… 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