Register
Recruit Create CV

Clinical Fraud Investigator Ii Jobs

Investigator Ii - Inmate Grievance
By Texas Department Of Criminal Justice At Texas City, TX, United States
Law Enforcement & Custodial Officers System (LECOS) Retirement
Telephonic Interviews Will Not Be Accepted
Work Site Visits Will Not Be Conducted
Graduation from an accredited senior high school or equivalent or
Three years full-time, wage-earning criminal justice, clerical,
The salary for an ERS Retiree (or non-contributing member) will
Investigator Ii - Inmate Grievance
By Texas Department Of Criminal Justice At Beeville, TX, United States
Law Enforcement & Custodial Officers System (LECOS) Retirement
Telephonic Interviews Will Not Be Accepted
Work Site Visits Will Not Be Conducted
Graduation from an accredited senior high school or equivalent or
Three years full-time, wage-earning criminal justice, clerical,
The salary for an ERS Retiree (or non-contributing member) will
Clinical Technician Ii Jobs
By Duke Health At , Durham, 27705
Alternatively, an equivalent combination of relevant education and/or experience.
Provide technical training to Medical Technology students and other clinical staff assigned to work area.
Confer with patient to obtain information for laboratory records, explain procedures, allay fears and elicit cooperation.
Utilize standard procedures for the maintenance of positive patient identification; record appropriate collection information on proper requisitions.
Perform various quality control procedures to maintain compliance with internal and external regulations.
Centrifuge, label and store blood samples for subsequent analysis by Clinical Laboratory staff.
Investigator Ii Jobs
By Biogen At Triangle, NC, United States
Ensures required management and Quality approvals on final investigations while satisfying established due dates.
Facilitates internal sharing of investigational findings and risk knowledge.
B.S. degree (STEM preferred) plus a minimum of 5 years of transferrable experience OR
A.S degree (STEM preferred) plus a minimum of 8 years of transferrable experience
Experience driving complex and/or high impact investigations in an industrial/plant environment
M.S. degree (STEM preferred) plus a minimum of 5 years of transferrable experience OR
Fraud Investigator I/Ii (Open And Promotional)
By County of San Mateo At , San Mateo, Ca $6,372 - $9,353 a month
Possess fluent Spanish language skills.
Possession of minimum qualifications does not guarantee advancement in the examination process.
Review, gather, evaluate and analyze evidence and information relating to the investigation of suspected welfare fraud.
Review a variety of records to secure information concerning suspected welfare violations.
Maintain records relating to investigations.
Prepare correspondence and reports of investigation findings; and make recommendations on investigations findings.
Investigator Ii Jobs
By Elevance Health At , Indianapolis, 46204, In
Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.
May interface internally with Senior level management and legal department throughout investigative process.
Fraud certification from CFE, AHFI, AAPC or coding certificates preferred.
2+ years of healthcare fraud investigation experience preferred.
Advanced Excel skills highly preferred.
Claims systems experience is a plus.
Clinical Admin Assistant Ii
By NorthShore University HealthSystem At , Evanston, 60201, Il
Education: High school diploma required. College degree preferred.
Experience: 3-5 years medical office or programmatic experience preferred
Knowledge and application of NorthShore policies and procedures that apply to job and area of responsibility.
Maintains productive and effective communications with patients and passing clinical questions to Physician/Practice Manager for follow up
Other duties as assigned by Practice Manager
o Knowledge of Microsoft Office suite Word and Excel, preferred
Investigator Ii Jobs
By Elevance Health At District of Columbia, United States
Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.
May interface internally with Senior level management and legal department throughout investigative process.
Fraud certification from CFE, AHFI, AAPC or coding certificates preferred.
2+ years of healthcare fraud investigation experience preferred.
Advanced Excel skills highly preferred.
Claims systems experience is a plus.
Investigator Ii Jobs
By Elevance Health At United States
Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.
May interface internally with Senior level management and legal department throughout investigative process.
Fraud certification from CFE, AHFI, AAPC or coding certificates preferred.
2+ years of healthcare fraud investigation experience preferred.
Advanced Excel skills highly preferred.
Claims systems experience is a plus.
Specialist Ii, Clinical Operations
By Cerevel Therapeutics At Boston, MA, United States
Assist with the development and implementation of processes and controlled documents in collaboration with Quality Management
Strong computer skills including knowledge of Office365, Microsoft SharePoint, Microsoft Excel, Microsoft Word, Microsoft PowerPoint, Outlook, and Microsoft Project
Collaborate/interact with internal and external stakeholders as related to conduct of required job responsibilities
Experience developing meeting agendas and finalizing meeting minutes
Ability to collaborate effectively with the study team, cross-functional team members and external partners (where needed) using collaborative negotiation skills
Experience using Microsoft Office suite products is preferred
Clinical Analyst Ii Jobs
By CereCore At United States
Maintain good time management for processes and projects and be transparent
Provides subject matter expertise as it relates to technical and/or operational solution requirements
Responsible for understanding operational/business requirements and translating them into system requirements
5+ Years of Position-Related Experience including:
Create or log an enhancement for creation of specialized queries at the request of nurse managers
Strong communication skills; ability to produce clear and complete system documentation
Investigator Ii Jobs
By Elevance Health At Lansing, MI, United States
Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.
May interface internally with Senior level management and legal department throughout investigative process.
Or any combination of education and experience, which would provide an equivalent background.
Requires a BA/BS and a minimum of 3 years related experience
Fraud certification from CFE, AHFI, AAPC or coding certificates preferred.
Health insurance, law enforcement experience preferred.
Investigator Ii - Elevance Health
By Elevance Health At Middletown, NJ, United States
Preferred Qualifications, Skills, And Experiences
Fraud certification from CFE, AHFI, AAPC, or coding certificates preferred.
New York, New York City
Privacy Notice for California Residents
How You Can Make An Impact
Be part of an Extraordinary Team
Clinical Specialist Ii Jobs
By University Health At San Antonio, TX, United States

4502 Medical Dr. Allied Health Rotating Shifts POSITION SUMMARY/RESPONSIBILITIES The Clinical Pharmacy Specialist II is responsible for the provision of comprehensive clinical pharmacy services ...

Complaint Investigator Ii Jobs
By City of Oakland, CA At , Oakland, 94612, Ca $97,135 - $119,262 a year
Any combination of education and experience that is equivalent to the following minimum qualifications is acceptable.
Committed to building safe communities. Your analytical skills will have a direct impact on improving policing conditions for marginalized BIPOC communities.
You will need to manage and prioritize critical deadlines.
Valuing Diversity: Appreciating the benefits of varied backgrounds and cultures in the workplace
Oral and written bilingual skills in Spanish, Mandarin, or Cantonese are highly desirable.
Work/Life Balance: 37.5 hour work weeks, and a flexible/hybrid remote schedule
Investigator Ii Jobs
By State of Delaware At , Wilmington, 19802, De
One year experience in conducting investigations which includes conducting interviews to obtain confidential information, gathering evidence and documenting findings.
One year experience in determining compliance with laws, rules, regulations, standards, policies and procedures.
One year experience in narrative report writing.
One year experience in civil, criminal or administrative proceedings.
One year experience in providing testimony before boards, commissions, administrative bodies, or court officials.
To learn more about the comprehensive benefit package please visit our website at https://dhr.delaware.gov/benefits/
Welfare Fraud Investigator I/Ii
By Merced County, CA At , Los Banos, Ca $58,573 - $78,603 a year
State Disability Insurance - Benefit based on highest quarter during previous calendar year. Employee pays premium.
EXTRA HELP EMPLOYEES DO NOT QUALIFY FOR COUNTY BENEFITS.
For answers to specific questions regarding employee benefits, please call Human Resources at 209.385.7682.
Anthem HDHP (High Deductible Medical Plan) with Health Savings Account (HSA)
Anthem HDHP (High Deductible Medical Plan) without Health Savings Account (HSA)
County pays 100% of the premium for employees and 50% for dependent(s)
Investigator Ii - Elevance Health
By Elevance Health At Albany, NY, United States
Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.
May interface internally with Senior level management and legal department throughout investigative process.
Fraud certification from CFE, AHFI, AAPC or coding certificates preferred.
Health insurance, law enforcement experience preferred.
Data analytics experience and demonstrated experience in use of Excel is strongly preferred.
2+ years investigative experience with fraud, waste and abuse within healthcare is preferred.
Investigator Ii Jobs
By Elevance Health At ,
May interface internally with Senior level management and legal department throughout investigative process.
BA/BS and minimum of 3 years related experience; or any combination of education and experience, which would provide an equivalent background.
Fraud certification from CFE, AHFI, AAPC or coding certificates preferred.
Pharmacy Investigative experience STRONGLY PREFERRED.
Date Posted: Apr 24, 2023
Effectively establish rapport and on-going working relationship with law enforcement.
Investigator Ii - Elevance Health
By Elevance Health At New York, NY, United States
Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.
Preferred Skills, Capabilities, And Experiences
May interface internally with Senior level management and legal department throughout investigative process.
Fraud certification from CFE, AHFI, AAPC or coding certificates preferred.
Hybrid, Work from home/In office (0-3 times per month)
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint

Are you looking for an exciting opportunity to investigate and prevent clinical fraud? We are looking for a Clinical Fraud Investigator II to join our team and help us protect our organization from fraudulent activities. You will be responsible for conducting investigations, analyzing data, and providing recommendations to management. If you have a passion for uncovering fraud and a keen eye for detail, this could be the perfect job for you!

Overview:

Clinical Fraud Investigator II is responsible for investigating and resolving fraud cases related to healthcare services. They are responsible for conducting detailed investigations into potential fraud cases, analyzing data, and making recommendations to management. They must be able to identify and analyze patterns of fraud and abuse and make recommendations to management on how to prevent and detect fraud.

Detailed Job Description:

Clinical Fraud Investigator II is responsible for conducting detailed investigations into potential fraud cases. They must be able to identify and analyze patterns of fraud and abuse and make recommendations to management on how to prevent and detect fraud. They must be able to analyze data and make recommendations to management on how to prevent and detect fraud. They must be able to communicate effectively with all levels of management and staff. They must be able to work independently and as part of a team.

What is Clinical Fraud Investigator Ii Job Skills Required?

• Knowledge of healthcare fraud and abuse laws and regulations
• Knowledge of healthcare billing and coding
• Knowledge of healthcare reimbursement systems
• Knowledge of healthcare fraud and abuse detection techniques
• Ability to analyze data and identify patterns of fraud and abuse
• Ability to communicate effectively with all levels of management and staff
• Ability to work independently and as part of a team
• Ability to use computer software programs to analyze data

What is Clinical Fraud Investigator Ii Job Qualifications?

• Bachelor’s degree in healthcare administration, business, or related field
• At least 3 years of experience in healthcare fraud and abuse investigations
• Certified Fraud Examiner (CFE) certification preferred
• Knowledge of healthcare fraud and abuse laws and regulations
• Knowledge of healthcare billing and coding
• Knowledge of healthcare reimbursement systems
• Knowledge of healthcare fraud and abuse detection techniques

What is Clinical Fraud Investigator Ii Job Knowledge?

• Knowledge of healthcare fraud and abuse laws and regulations
• Knowledge of healthcare billing and coding
• Knowledge of healthcare reimbursement systems
• Knowledge of healthcare fraud and abuse detection techniques
• Knowledge of computer software programs to analyze data

What is Clinical Fraud Investigator Ii Job Experience?

• At least 3 years of experience in healthcare fraud and abuse investigations

What is Clinical Fraud Investigator Ii Job Responsibilities?

• Conduct detailed investigations into potential fraud cases
• Analyze data and identify patterns of fraud and abuse
• Make recommendations to management on how to prevent and detect fraud
• Communicate effectively with all levels of management and staff
• Work independently and as part of a team
• Use computer software programs to analyze data