Senior FWA Investigator - Healthcare Claims & Compliance
Hispanic Alliance for Career Enhancement
Hispanic Alliance for Career Enhancement seeks a Sr. Analyst for Fraud, Waste, and Abuse (FWA) detection and investigation. The role involves analytical review of claims data, referencing regulatory agencies, and collaboration across departments to prevent misconduct. Candidates must have strong analytical skills and relevant coding certification. The position offers a comprehensive benefits package including health coverage, paid time off, and retirement savings options. #J-18808-Ljbffr
- A healthcare provider in the Town of Florida is seeking a detail-oriented Medical Biller to manage billing processes and ensure compliance with healthcare regulations. Responsibilities include reviewing... ...accuracy, and following up on claims. Candidates should have 5 years...SeniorClaims
- Job Description: As a Senior Manager in Healthcare Revenue Cycle Management, you will be responsible for... ...analyzing, resolving, and preventing claim denials. Your expertise will directly... ...the team to ensure efficiency and compliance. Provide regular reporting to internal...SeniorClaimsLocal areaRemote work
- ...FCCI in the United States is hiring a Surety Claim Specialist to handle complex surety claims, evaluate exposures, and manage settlements. This role requires substantial experience in surety law and excellent analytical skills. Applicants should possess a Bachelor's degree...SeniorClaimsRemote work
$46.99k - $122.4k
...disciplinary provider groups in a prepayment environment Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc.... ...agencies in the investigation and prosecution of healthcare fraud and abuse matters. Demonstrates high level...SeniorClaimsHourly payFull timeTemporary workLocal area- ...NAPA Management Services Corporation is seeking a qualified candidate for a role in healthcare claims management. Responsibilities include managing follow-ups on unpaid claims and collaborating with internal and external resources to resolve issues effectively. The...SeniorClaims
$21.82 - $42.55 per hour
...Description Provides investigative support for special investigation... ..., waste and abuse (FWA). Investigates and... ...of post-payment claims. Essential Job Duties... ...Certified Professional Compliance Officer (CPCO). Certified... ...and Compensation Molina Healthcare offers a competitive...ClaimsHourly payContract workWork experience placementWork at officeLocal area$107.7k - $199.3k
...York seeks a highly skilled individual to lead and manage complex internal investigations. This role requires exceptional judgment and the ability to guide senior management while ensuring compliance with federal and state regulations. The ideal candidate will have 7+...SeniorRemote job$87.7k - $157.8k
...the day-to‑day execution of the Medicare Compliance Advisory program in alignment with CMS... ...detection, and correction of noncompliance and FWA. Execute assignments, ensuring timely,... ...’s degree in a related field (e.g., healthcare administration, public health, policy) or...SeniorClaimsFull timePart timeWork at officeRemote workFlexible hours- Nerdleveltech is looking for a Bilingual Spanish Junior Healthcare Fraud Investigator based in New York. This role is ideal for recent graduates with... ...engage in audits/investigations of potentially fraudulent claims. The position demands exceptional analytical skills,...ClaimsRemote job
- The Senior Clinical Coder serves as a subject matter... ...accuracy, regulatory compliance, and appropriate reimbursement... ...retrospective claims reviews, provide expert... ...improvement in healthcare operations. Duties &... ...favorable background investigation Desired Qualifications...SeniorClaimsFull timeWork at officeRemote workWork from homeHome office
$46.99k - $122.4k
CVS Health, located in Town of Florida, New York, is seeking a Fraud Investigator with experience in healthcare fraud and abuse investigations. The role involves handling complex cases, conducting investigations, and documenting findings efficiently. The ideal candidate...SeniorFull time$45.39k - $88.51k
Molina Healthcare in California is seeking a Claims Supervisor to lead the claims activities team. Responsibilities include supervising claims processing, managing team performance, and analyzing claims reports to improve efficiency. Ideal candidates will have over 5 years...SeniorClaims$21.82 - $42.55 per hour
Molina Healthcare in New York is seeking an investigator to provide support for special investigation unit (SIU) activities. The role involves investigating health care fraud and abuse, requiring strong analytical, interpersonal, and investigative skills. Candidates should...Hourly pay$78k - $82k
...an alternative application process. Senior Encounters Analyst Full Time Staff South... ...Position Summary: Make an Impact on Healthcare Data, Compliance, and Strategy Community Care Plan is... ...Experience with encounter data, healthcare claims, or healthcare reporting Strong SQL...SeniorClaimsFull timeRemote work- A healthcare staffing company is seeking an experienced Medical Billing Manager to oversee billing operations... .... This role involves ensuring timely claims submission, monitoring accounts receivable, and maintaining compliance with healthcare regulations. Excellent communication...SeniorClaims
- ...maximizing their potential and carrying value forward into the healthcare system and people’s everyday lives. This means understanding and... .... Proficiency in SQL and PowerBI. Healthcare revenue cycle or claims experience is strongly preferred. Excellent analytical and problem...SeniorClaims
$66k - $112k
...accessible, high-quality, and sustainable healthcare for all. Medical Coding Automation Senior Associate We are looking for a... ..., reduce denials, optimize claim adjudication outcomes, and strengthen... ...to medical coding standards, compliance guidelines, and coding quality expectations...SeniorClaimsTemporary work$117.5k - $234.5k
...processes, including: Asset Protection/Property Loss Control. Claims Management. Mergers, Acquisitions & Divestitures. Contract Reviews... ...business partners. Support Carrier's entities to ensure compliance with local policies and regulatory insurance requirements. Provide...SeniorClaimsContract workTemporary workLocal area$50k - $60k
...oversee daily operations in medical revenue cycle management. You will lead claims processing, denial management, and collections, maximizing revenue capture and ensuring compliance with healthcare regulations. The ideal candidate will have 5+ years of experience in RCM,...Claims- A healthcare solutions provider is seeking a Registered Nurse for Claims & Appeals Review. This remote role supports compliance and quality assurance in appeal reviews. Candidates should have a Bachelor's degree in healthcare and valid RN license in Florida. Key responsibilities...ClaimsRemote job
$214.4k - $321.6k
...and government pricing (price reporting compliance; reasonable assumptions documents). Review... ...plans. Stay current on evolving healthcare laws/regulations and enforcement. Ensure... ...transparency; OIG guidance/opinions; False Claims Act; PhRMA Code). Strong verbal/written...SeniorClaimsRemote workFlexible hours- Senior Systems Support Analyst, Infrastructure and Security About... ...solutions, including coding and claims management and the latest... ...had a clear vision of a better healthcare system and have continually... ...maintaining system security and compliance standards Assist in...SeniorClaims
- A leading healthcare provider in New York seeks a Clinical Research Coordinator II to manage study subjects' enrollment and compliance. The successful candidate will enhance their clinical research experience while overseeing a greater study workload. Key responsibilities...Senior
$81.33k - $104.74k
...A prestigious healthcare institution in New York is seeking a Manager-HVAC Operations to oversee all HVAC activities, ensuring compliance and efficient operation across the hospital's systems. The ideal candidate will have a Bachelor's degree in Engineering and 4-6 years...Senior$67.9k - $199.14k
...an exciting opportunity for a Senior Informatics Manager to join... ...analytics, interpreting large healthcare datasets, and translating findings... ...medical and pharmacy claims, encounter, provider, and membership... ...stakeholders Support compliance with CMS and state Medicaid requirements...SeniorClaimsRemote jobHourly payFull timeTemporary workWork experience placementLocal area- ...revenue cycle operations by reviewing denied claims for clinical accuracy and medical... ...improving reimbursement outcomes, and ensuring compliance with payer policies and clinical... ...HBiz Work Environment HBiz partners with healthcare organizations nationwide to improve revenue...ClaimsRemote work
- A Florida-based consulting firm is seeking a Senior Project Manager to oversee construction projects, manage budgets, and ensure compliance with safety regulations. The ideal candidate will have over 10 years of Project Management experience and OSHA certification. Responsibilities...Senior
- Integrated Home is seeking a Senior Human Resources Generalist who will serve as a strategic... ...relations, performance management, compliance, and talent acquisition. The ideal candidate... ...4 years of HR experience, preferably in healthcare, and strong knowledge of labor laws....SeniorFull time
- Suvida Healthcare is seeking a Risk Adjustment Coder to enhance the documentation and coding... ...reviews of medical records and ensuring compliance with federal and state guidelines. Ideal... ...impact on the lives of our cherished seniors. #J-18808-Ljbffr SuvidahealthcareSenior
- ...services company is seeking an experienced Senior Counsel to provide legal support... ...on commercial contracts and regulatory compliance. The role involves advising on regulatory... ...This position is ideal for candidates with healthcare experience and strong analytical skills....Senior
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