- Molina Healthcare (Ann Arbor, MI)
- **JOB DESCRIPTION** **Job Summary** The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical ... School Diploma / GED (or higher) **Required Experience** + 3+ years CPT coding experience (surgical, hospital, clinic settings) or 5+ years of experience working in… more
- Molina Healthcare (Covington, KY)
- …responsible to lead a small team of investigators and provide oversight on daily investigative activities as a back-up to the SIU Manager. This position will be ... integrity programs. The position must have the ability to determine correct coding , documentation, potential fraud, abuse, and over utilization by providers and… more
- UPMC (Pittsburgh, PA)
- …formfieldid="descriptionInt" UPMC Health Plan has an exciting opportunity for a Special Investigations Unit Investigator position. This is a temporary ... This is a remote position. Under the direction of the manager, the Special Investigations Unit (SIU) Investigator is responsible for investigating assigned… more
- Point32Health (Canton, MA)
- …more about who we are at Point32Health (https://www.point32health.org/) . **Job Summary** The Investigator I is an essential team member of the Special ... and abuse, and developing action plans to address the investigative findings and prevent future loss. This role will...the direction of the Manager, FWA Prepayment Review. The Investigator I works closely with other members of the… more
- Sanford Health (Fargo, ND)
- …data analytics, investigation, claim auditing and other areas related to Special Investigations. Completes reports of investigative findings and recommends ... investigation/audit. - Master's Degree preferred - Accredited Health Care Fraud Investigator (AHFI) certification or Certified Fraud Examiner (CFE) preferred -… more
- MVP Health Care (Tarrytown, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Clinical Investigator ** to join #TeamMVP. This is the opportunity for you if you have ... investigation experience involving economic or insurance related matters. + A clinical investigator must have in addition to the above requirements: A duly licensed… more
- Centene Corporation (Frankfort, KY)
- …compliance and fraud, waste, and abuse related matters; while maintaining an investigative workload of moderate to high complexity. Assists manager on monitoring ... while meeting all regulatory, CMS, and WellCare Corporate guidelines in which special care is required to protect and enhance WellCare's reputation. + Works… more
- The County of Los Angeles (Los Angeles, CA)
- …in the master key system. Establishes, expands, and modifies master key coding systems. Issues keys and locks and keeps related distribution records. Operates ... objects weighing over 25 pounds, and frequent lifting of 10-25 pounds. SPECIAL REQUIREMENT INFORMATION *Journey-level experience applies to a person who has… more
- Mount Sinai Health System (New York, NY)
- …and physician leadership, this position works closely with Revenue Integrity, Coding , Billing, Cash Posting, and Case Management in defining vision, strategy ... resolves conflicts regarding public accounting firms, third-party auditors, and investigative parties. + Fiduciary responsibility for ensuring that compliance… more