- Humana (Sacramento, CA)
- …part of our caring community and help us put health first** The Senior Fraud and Waste Professional conducts investigations of allegations of fraudulent and ... abusive practices. The Senior Fraud and Waste Professional work assignments involve moderately complex to complex issues where the analysis of situations or data… more
- Humana (Sacramento, CA)
- …a part of our caring community and help us put health first** The Senior Fraud and Waste Professional (Program Integrity Lead) is responsible for overseeing the ... monitoring and enforcement of the Fraud , Waste , and Abuse (FWA) program. This role aims to prevent and detect potential FWA activities in accordance with state… more
- Humana (Sacramento, CA)
- …a part of our caring community and help us put health first** The Fraud and Waste Professional 2 conducts investigations of allegations of fraudulent and ... abusive practices. The Fraud and Waste Professional 2 work assignments are varied and frequently require interpretation and independent determination of the… more
- Humana (Sacramento, CA)
- …part of our caring community and help us put health first** The Manager, Fraud and Waste Investigator : Nurse Audit/Review performs clinical audit/validation ... and determines approach, resources, schedules and goals. The Manager, Fraud and Waste Investigator : Nurse Audit/Review validates and interprets medical… more
- Highmark Health (Sacramento, CA)
- …Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud Investigator (AHFI) **SKILLS** + Must have knowledge of provider ... for conducting investigations of organizational or functional activities related to alleged fraud , waste and abuse perpetrated by providers, members, facilities,… more
- Providence (Oakland, CA)
- …software/tools. **Preferred Qualifications:** + Current certification as an Accredited Healthcare Fraud Investigator (AHFI) upon hire. + Certification as an ... **Description** ** Investigator External Audit Special Investigations Unit \*Remote The...to coding, medical record documentation requirements, healthcare compliance and fraud , waste and abuse to Health Plan… more
- Centene Corporation (Sacramento, CA)
- …and measure potential healthcare fraud and abuse. + Conduct investigations of potential waste , abuse, and fraud + Document activity on each case and refer ... in claims + Develop new queries and reports to detect potential waste , abuse, and fraud + Provide case updates on progress of investigations and coordinate with… more
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