- State of Georgia (Fulton County, GA)
- …Georgia Medicaid Program. Participates as a member of an interdisciplinary team in Healthcare fraud investigations, and provides support to members of other ... services and eligibility of providers as requested. + Assists prosecutors in Healthcare Fraud investigations by reviewing provider and patient records. +… 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, ... researches, analyzes, and provides regulatory compliance advice on the Fraud and Abuse + Laws, including, but not limited...the False Claims Act, Civil Monetary Penalties, and + Medicare and Medicaid billing regulations (including CMS, Medicare… more
- Atlantic Health System (Morristown, NJ)
- …(iv) accountable care organization compliance; (v) Medicare C & D/ Medicare Advantage compliance program requirements; (vi) Federal healthcare program ... compliance risk areas: (i) general compliance and compliance program effectiveness; (ii) fraud , waste and abuse and Deficit Reduction Act of 2005 workforce member… more
- KPH Healthcare Services, Inc. (Oklahoma City, OK)
- …plans and any changes that possibly may occur within the Insurance Payor, Medicare , or Medicaid + Responsible for completing all mandatory and regulatory training ... the specific position **Required Training:** + HIPPA Privacy & Security Course + Fraud , Waste, and Abuse Course **Job Skills Required:** + Exceptional attention to… 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
- Option Care Health (Bannockburn, IL)
- …in Healthcare Compliance (CHC), Certified Internal Auditor (CIA), Certified Fraud Examiner (CFE), or similar certification preferred. + Direct experience in home ... that attracts, hires and retains the best and brightest talent in healthcare . **Job Description Summary:** The Analyst, Compliance Auditing, Monitoring and Analytics… more
- Atlantic Health System (Morristown, NJ)
- …prior experience with hospitals, Medicare and Medicaid, and federal and state healthcare regulatory issues, including fraud and abuse, the Stark Law, the ... monitoring of regulatory developments, and legal research on regulatory issues, including fraud and abuse issues, HIPAA compliance, EMTALA, Medicare and Medicaid… more
- University of Rochester (Rochester, NY)
- …compliance with Medicare , Medicaid, and third-party payer billing regulations, and fraud , waste, and abuse prevention. + Serves as a resource and subject matter ... conducts investigations, risk assessments, and regulatory monitoring to prevent and detect fraud , waste, and abuse, specifically addressing the DRA, NY SSL | 363-d,… more
- UnityPoint Health (Cedar Rapids, IA)
- …hospital and department compliance for federally funded healthcare programs (eg Medicare and Medicaid) regarding fraud , waste and abuse. Brings any questions ... and department compliance requirements for federally funded healthcare programs (eg Medicare and Medicaid) regarding fraud , waste and abuse. Brings any… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- … Medicare Advantage risk adjustment methodology, coding guidelines (ICD-10-CM), healthcare compliance, and billing practices. * Proficiency in Excel and ... are looking for dedicated and motivated individuals who share our vision of transforming healthcare . As a Blue Cross associate, you are joining a culture that is… more