- State of Minnesota (St. Paul, MN)
- **Working Title: Medicaid Provider Audits and Investigations Manager** **Job Class: Human Services Manager 2** **Agency: Human Services Dept** + **Job ... The incumbent manages anti-fraud, waste, and abuse efforts, including provider investigations , prevention, education, and enforcement activities.… more
- Commonwealth Care Alliance (Boston, MA)
- …regulations, and CMS payment methodologies (eg, DRG, APC, RBRVS). + Support provider appeal reviews and internal payment integrity investigations by providing ... post-payment audits . + Assist in the resolution of complex provider disputes and escalations, including direct support to leadership in pricing determinations… more
- NTT America, Inc. (Little Rock, AR)
- …adaptable, and forward-thinking organization, apply now. We are currently seeking a Medicaid Privacy Auditor to join our team in Little Rock, Arkansas (US-AR), ... with the DHS Privacy Officer, will be a key contributor in conducting audits and other services for the DHS Privacy Office. These services include: conducting… more
- LA Care Health Plan (Los Angeles, CA)
- Director, Compliance on Special Investigations Unit and Fraud, Waste and Abuse Job Category: Administrative, HR, Business Professionals Department: Special ... Investigations Unit Location: Los Angeles, CA, US, 90017 Position...public agency created by the state of California to provide health coverage to low-income Los Angeles County residents.… more
- State of Georgia (Fulton County, GA)
- …the Attorney General. The position filled through this announcement will serve within the Audits section of the Medicaid Fraud Division. Job Summary Under the ... direction of the Fraud Unit Director, assists in healthcare investigations by: reviewing provider and recipient records, by making determinations of medical… more
- AmeriHealth Caritas (Columbus, OH)
- …two years of experience in the healthcare field working in fraud, waste, and abuse investigations and audits OR + An associate's degree, with a minimum of four ... years of experience working in healthcare fraud, waste, and abuse investigations and audits . + Experience and training/certifications commensurate with position… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …include: A minimum of five years in the healthcare field working in FWA investigations and audits ; or five years of insurance claims investigation experience or ... include substantiating referrals, case planning and research, conducting onsite or desk audits , clinical reviews of medical records to ensure correct billing of… more
- Humana (Springfield, IL)
- …System Validations for Universe and State reports + Prepare cases, present cases and/or provide navigation responsibilities for CMS audits and State audits + ... plan, and annual evaluation. The Quality Improvement Professional performs quality investigations to implement and support quality improvement initiatives for the… more
- Molina Healthcare (Louisville, KY)
- …emphasis on fraud investigations . + Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. + Understanding of claim billing ... fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. The SIU Investigator… more
- CVS Health (Charleston, WV)
- …accreditation from the National Health Care Anti-Fraud Association (AHFI) + Experience In Medicaid Compliance, Medicaid Investigations , MCO Medicaid FWA ... comply with state regulations mandating fraud plans and reporting; Medicaid experience is preferred. Leads a team in the...5 years of managing healthcare fraud, waste and abuse investigations and audits . + 3 to 5… more
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