Fraud & Coding Compliance Specialist
University Health System- San Antonio
Community First Health Plans is seeking a Code and Documentation Compliance Specialist-CFHP to join the SIU team. The role focuses on advanced coding audits, data collection, and generating statistical reports to support compliance with federal and state regulations. The candidate will conduct investigations related to fraud and abuse, review eligibility, claims, and provider contracts, and help educate staff and physicians based on findings from audits. #J-18808-Ljbffr University Health System- San Antonio
$22.1 - $38.25 per hour
...Performs at the advanced skill level of a Coding Specialist. Is adept at data collection and... ...administrative investigations related to fraud and abuse. Will conduct research related... ...of coding and documentation to ensure compliance with federal and state laws and regulations...FraudFull timeContract workFor contractorsWork at office- ...infrastructure using Terraform (Infrastructure as Code). This includes establishing best... ..., the role demands strong awareness of compliance, security, and regulatory requirements. The... ...-critical functions such as payments, fraud detection, or core banking systems. Performance...FraudPermanent employmentContract workRemote work
- ...do. Work within our Financial Risk and Compliance IT team and be part of a team that helps... ...Banking experience in KYC, AML, Sanctions, Fraud and Compliance systems with strong... ...projects. Experience with development coding and relational database (SQL) queries....FraudWork experience placementRemote workFlexible hours
- ...management, architecture, security, and compliance teams to define technical requirements and... ...innovative solutions.Actively participate in coding, code reviews, and hands-on technical... ...technologies using API standards.Familiarity with fraud detection/prevention systems, risk...FraudFull time
- ...integrations. The Director ensures full compliance with all government (federal and state) regulations... ...readiness and reduce risk of error or fraud. *Ensure accurate and timely record... ...dimensions to promote consistent coding, accurate reporting, and alignment with organizational...FraudContract workWork at officeLocal areaNight shift
$164.78k - $314.96k
...risk appetite. You will own operational and compliance risk inherent in credit strategy.... .../data for use in identifying first party fraud.Leverages industry knowledge and competitive... ...copilots and similar technologies) to enhance coding productivity, accelerate analytical...FraudFull timeH1bWork at officeRemote workHome officeShift work$19.8 - $31.25 per hour
POSITION SUMMARY/RESPONSIBILITIES The Compliance & Regulatory Specialist is responsible for assisting in the oversight and execution of compliance in the health plan’s operational areas, including delegated operational activities and regulatory reporting. The candidate...Full timeWork at office- ...culture supports you in building a solid career with a great team you can count on day in and day out for the long term.The Trade Compliance Specialist is a critical member of the trade compliance team and responsible for executing core trade compliance activities across...Full timeLocal areaWorldwideFlexible hours
- ...oriented Senior Integrity Auditor to join our Compliance team. This pivotal role is responsible... ...audits and reviews in areas such as coding, billing, medical record documentation, claims... ...structures to prevent and detect errors, fraud, waste, and abuse. - Assist in other...Fraud
- ...customers’ world, reveal unknowns and deliver integrated solutions. We are seeking a detail-oriented and proactive Regulatory Compliance Specialist to join our Quality & Compliance team. In this role, you will be instrumental in ensuring our products meet regulatory...Work at office
- TechWish in San Antonio, Texas is in search of an HR Consultant to oversee the administration and compliance of pension programs under the Overseas Military Banking Program. This role involves managing daily operations, responding to pension inquiries, and coordinating...Overseas
- EControls seeks a detail-oriented Regulatory Compliance Specialist to join the Quality & Compliance team. You will help ensure products meet international standards, coordinate third-party audits, and manage certification documentation across multiple product lines. Responsibilities...
- QuickCruit, Inc. is seeking a Regulatory Compliance Specialist in San Antonio, TX. You will support UL and CSA compliance, coordinate third-party factory audits, and help maintain certification documentation. In this role, you plan testing for AGA and ECE e4 requirements...
- ...Connections is seeking an experienced Leave of Absence Administrator to oversee the comprehensive administration, tracking, and compliance of the organization’s leave programs. The role provides high-touch support and clear communication to employees throughout their...
- ..., and delivering preventative maintenance services. Job Description Perform multi-point vehicle inspections to ensure compliance with emissions standards and state regulations. Document inspection results and maintain accurate records. Communicate pass...Full timeLocal areaFlexible hours
- ...career centers, sector-focused centers and community, and partner sites. Job Description Conduct scheduled and unannounced on-site compliance monitoring visits within the assigned geographic region. Perform file and documentation reviews to verify compliance with program...For contractorsWork at officeLocal area
- Equus Workforce Solutions in San Antonio, TX is seeking a Compliance Monitor to conduct on-site and unannounced visits, review files, and verify program compliance across the Alamo Region. You will interview contractors, collect and analyze data, identify deficiencies,...For contractors
- ...needs of a production environment. Position Summary Steves & Sons is seeking an experienced and results-driven Recruitment Compliance Specialist (Manufacturing Recruiter) to support recruiting efforts for our manufacturing operations. This position is ideal for a hands...Hourly pay
- A growing technology company in San Antonio is looking for a Community Admin Specialist to focus on data analysis and compliance. This fully remote position involves working closely with community partners to enhance homelessness response systems. The successful candidate...Remote job
- Community First Health Plans seeks a Compliance & Regulatory Specialist to help oversee and execute compliance across operations and delegated activities. You will coordinate regulatory deliverables and assist with interpreting changes in guidelines, including HIPAA, to...
$36.59k
...Job Description Job Description Compliance Specialist Compensation: $36,586 + commission (OTE $100,000) Type: FTE, Salaried Exempt Location : Daily local travel within assigned city (Texas) Eligibility : US Permanent Residency is required for this role...Permanent employmentWork at officeLocal areaRemote workWork from home- ...inquisitive mind and a thirst for knowledge? Do you enjoy identifying potential risk and finding a solution? If so, being an IT Compliance Specialist with Frost could be for you.At Frost, it’s about more than a job. It’s about having a flourishing career where you can...Full time
- ...inspections and provide reliable, preventative maintenance services. This role plays a critical part in ensuring vehicle safety, compliance, and customer confidence. What You'll Do Perform state-mandated vehicle inspections and multi-point safety checks Ensure...Full timeLocal areaImmediate startFlexible hours
- ...performing services as a Lube Technician. Job Responsibilities: Perform multi-point Inspection of automotive vehicles to ensure compliance to emission standards and governmental regulations and maintain detailed records of vehicles inspected. Communicate whether vehicle...Full timeTemporary workLocal areaFlexible hours
- ...knowledgeable product administrator to develop and support CPI, GAP, MBI, VSC, and LPI programs, ensuring accuracy and regulatory compliance. You will troubleshoot issues, coordinate with IT, and onboard Financial Institutions to these products. The role requires strong...
- ...of services provided to client and client activity, protect the client’s health care information and report potential fraud and abuse to the compliance officer. Consistently use proper body mechanics and use proper infection control techniques to maintain environmental...Fraud
- ...inspections and provide reliable, preventative maintenance services. This role plays a critical part in ensuring vehicle safety, compliance, and customer confidence. Join a team that values growth and hands-on training, with opportunities to advance within automotive and...
$18.75 - $24.25 per hour
...Kids and STAR+PLUS program either by phone or in person. Ensures compliance with the Health Insurance Portability and Accountability Act (... ...policies such as Abuse, Neglect and Exploitation (ANE), Fraud, Waste, and Abuse (FWA) in regards to all aspects of operations...FraudFull time- ...litigator with a minimum of 8 years' experience in relevant fields such as toxic tort, asbestos, general liability, employment, bad faith/fraud, or insurance defense. While trial experience is a plus, it is not a mandatory requirement. The position offers the opportunity to...Fraud
- ...provide accurate, courteous service. You will balance tills, handle transactions securely, verify IDs, and follow procedures to prevent fraud while supporting branch goals. A team-oriented attitude and strong numerical skills are essential in this fast-paced retail...Fraud
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