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70 đź’Ľ Healthcare Fraud Jobs / Employment

Support Clerk - Healthcare

new1 day ago
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…benefits packages, but the opportunity to create a meaningful impact in jobs and on projects that matter. Perspecta's talented and robust workforce-14,000

jobs byJuju.com

NURSING CARE ASST I/HEALTH UNIT COORD - Peds

new2 days ago
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Auto req ID 109900BR Duke Entity DUKE HOSPITAL Job Code 4240 NURSING CARE ASST I/HEALTH UNIT COORD Job Description Occupational Summary Perform a variety of nonprofessional nursing duties in the direct care of patients under the direct supervision of an RN/LPN. Perform a variety of clerical duties involved in preparing, maintaining, and processing patient, unit (s) and hospital data and records to include operating the organization's patient care information systems. Work Performed Administer treatment and personal care procedures to patients including, but not limited to, feeding, bathing, shaving changing clothing, cleaning and trimming fingernails, bed-making, assisting with ambulation, enemas, skin care, and bowel and bladder elimination; provide such additional care as required to meet the personal needs and comfort of assigned patients. Perform a variety of selected patient care tasks under the direction of an RN/LPN to assist medical and nursing personnel in the examination, treatment and care of patients. Retrieve and record patient data in electronic medical records (EMR) and report to Nurse noting any new abnormal changes in the patient's condition. Participate in the transport of patients. Clean assigned area; stock and replenish supplies and equipment as required. Perform a variety of clerical tasks involved in operating the organization's patient care information system. Acknowledge orders on EMR task list , verify printout and input verified orders to request diets, treatments, nursing services, equipment and diagnostic and laboratory tests and procedures. Assemble and maintain patient charts from admission through discharge Prepare and upload paper documents into the electronic medical record (EMR). Exhibit professional communication skill when answering the telephone and interacting with patients, visitors and other staff members. Navigate electronic medical record, access patient information, generate reports, schedule appointments and manage task list. Use available technology to request and coordinate patient transport. Assign nursing staff to communication systems. Perform other related duties incidental to the work described herein. Knowledge Skills and Abilities Working knowledge of sterile techniques and special procedures that are applicable to work performed Working knowledge of procedures and techniques involved in administering routine and special treatments to patients Working knowledge of sanitation, personal hygiene and basic health and safety precautions applicable to work in a hospital Working knowledge of infection control procedures and safety precautions Ability to withstand prolonged standing and walking Heavy lifting and the ability to transport stretcher and wheelchair patients to various hospital locations may be required. Ability to understand and follow oral and written instructions. Ability to document and communicate pertinent information using computer and/or paper documentation tools Knowledge and understanding of telephone etiquette Working knowledge of general clerical practices and procedures Working knowledge of spelling and medical terminology. Ability to apply specific departmental rules and regulations relating to verifying, processing and maintaining records and forms Ability to organize and set priorities Ability to operate a computer terminal and other office equipment Ability to deal tactfully and courteously with the public Ability to establish and maintain effective relationships with other personnel Working knowledge of principles and practices of providing non- professional bedside patient care Basic knowledge and the ability to use technology to include computers, scanners, communication system and other systems. Level Characteristics N/A Location Durham Requisition Number 401557347 Position Title NURSING CARE ASST I/HEALTH UNIT COORD - Peds Shift Rotating Job Family Level B2 Full Time / Part Time FULL TIME Regular / Temporary Regular Department Name PEDIATRIC PROGRESSIVE CARE UNIT (PPCU) Minimum Qualifications Duke University is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status. Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values. Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department. Education Completion of a Level I - Nurse Aide education program approved by the North Carolina Board of Nursing or successful completion of the NC - approved Nurse Aide I competency test. High school diploma or equivalent required. Experience N/A Degrees, Licensures, Certifications Currently listed as a Nursing Assistant (NAI) with the Division of Facility Services with no substantiated findings or pending of abuse, fraud, neglect or misappropriation of property. AHA Basic Healthcare provider certification must be maintained/ completed by the end of new hire orientation, which typically takes place during the first week of employment.

jobs byAdzuna

NURSING CARE ASST I/HEALTH UNIT COORD - Nursery

new2 days ago
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Auto req ID 109855BR Duke Entity DUKE HOSPITAL Job Code 4240 NURSING CARE ASST I/HEALTH UNIT COORD Job Description Occupational Summary Perform a variety of nonprofessional nursing duties in the direct care of patients under the direct supervision of an RN/LPN. Perform a variety of clerical duties involved in preparing, maintaining, and processing patient, unit (s) and hospital data and records to include operating the organization's patient care information systems. Work Performed Administer treatment and personal care procedures to patients including, but not limited to, feeding, bathing, shaving changing clothing, cleaning and trimming fingernails, bed-making, assisting with ambulation, enemas, skin care, and bowel and bladder elimination; provide such additional care as required to meet the personal needs and comfort of assigned patients. Perform a variety of selected patient care tasks under the direction of an RN/LPN to assist medical and nursing personnel in the examination, treatment and care of patients. Retrieve and record patient data in electronic medical records (EMR) and report to Nurse noting any new abnormal changes in the patient's condition. Participate in the transport of patients. Clean assigned area; stock and replenish supplies and equipment as required. Perform a variety of clerical tasks involved in operating the organization's patient care information system. Acknowledge orders on EMR task list , verify printout and input verified orders to request diets, treatments, nursing services, equipment and diagnostic and laboratory tests and procedures. Assemble and maintain patient charts from admission through discharge Prepare and upload paper documents into the electronic medical record (EMR). Exhibit professional communication skill when answering the telephone and interacting with patients, visitors and other staff members. Navigate electronic medical record, access patient information, generate reports, schedule appointments and manage task list. Use available technology to request and coordinate patient transport. Assign nursing staff to communication systems. Perform other related duties incidental to the work described herein. Knowledge Skills and Abilities Working knowledge of sterile techniques and special procedures that are applicable to work performed Working knowledge of procedures and techniques involved in administering routine and special treatments to patients Working knowledge of sanitation, personal hygiene and basic health and safety precautions applicable to work in a hospital Working knowledge of infection control procedures and safety precautions Ability to withstand prolonged standing and walking Heavy lifting and the ability to transport stretcher and wheelchair patients to various hospital locations may be required. Ability to understand and follow oral and written instructions. Ability to document and communicate pertinent information using computer and/or paper documentation tools Knowledge and understanding of telephone etiquette Working knowledge of general clerical practices and procedures Working knowledge of spelling and medical terminology. Ability to apply specific departmental rules and regulations relating to verifying, processing and maintaining records and forms Ability to organize and set priorities Ability to operate a computer terminal and other office equipment Ability to deal tactfully and courteously with the public Ability to establish and maintain effective relationships with other personnel Working knowledge of principles and practices of providing non- professional bedside patient care Basic knowledge and the ability to use technology to include computers, scanners, communication system and other systems. Level Characteristics N/A Location Durham Requisition Number 401556574 Position Title NURSING CARE ASST I/HEALTH UNIT COORD - Nursery Shift Rotating Job Family Level B2 Full Time / Part Time FULL TIME Regular / Temporary Regular Department Name INTENSIVE CARE NURSERY (ICN) Minimum Qualifications Duke University is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status. Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values. Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department. Education Completion of a Level I - Nurse Aide education program approved by the North Carolina Board of Nursing or successful completion of the NC - approved Nurse Aide I competency test. High school diploma or equivalent required. Experience N/A Degrees, Licensures, Certifications Currently listed as a Nursing Assistant (NAI) with the Division of Facility Services with no substantiated findings or pending of abuse, fraud, neglect or misappropriation of property. AHA Basic Healthcare provider certification must be maintained/ completed by the end of new hire orientation, which typically takes place during the first week of employment.

jobs byAdzuna

Medical Review RN Manager - Healthcare Fraud

new3 days ago
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…benefits packages, but the opportunity to create a meaningful impact in jobs and on projects that matter. Perspecta's talented and robust workforce-14,000

jobs byJuju.com

VP, MIS Infrastructure

4 days ago
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Job Description: **Role Summary/Purpose:** Reporting to the VP, Fraud Technology and MIS the VP, MIS Infrastructure will lead and drive the performance of the MIS

jobs byJuju.com

CS - Claims Processor - Intermediate

5 days ago
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Adecco is currently assisting a local client in their search to fill? P rovider Enrollment Specialist? in Eden Prairie, MN The EPS Provider Enrollment Specialist will be responsible for performing the appropriate processes to enroll and maintain enrollment for Optum Electronic Statements and Payments (EPS) providers. The Specialist will review, investigate and process enrollment using the Optum EPS applications. Conducts data entry and re-work; analyzes and identifies trends and provides reports as necessary.? Responsibilities:? • Provide expertise or general support by reviewing, researching, investigating, processing and adjusting EPS enrollments? • Authorize enrollment or refer to investigators for further review analyze and identify trends and provides reports as necessary? • Strive for provider service excellence? • Consistently meet established productivity, schedule adherence and quality standards? • Proficiency with Windows PC applications, which includes the ability to learn new and complex computer system applications? • Safeguard transactions and escalate when applicable? • Adapt to changing business objectives? • Verify true providers and the activity on their account? • Thoroughly review enrollment items for fraudulent activity? • Apply expanded knowledge base of fraud schemes to assist in handling of specialized fraud functions such as identity theft and cross-channel fraud? • Other duties as assigned? Position Requirements:? • Ability to sit/stand for extended periods of time? • Proficiency with Windows PC applications, which includes the ability to learn new and complex computer system applications? • Ability to manage multiple systems and applications? • Ability to multi-task - this includes ability to understand multiple products and multiple levels of benefits within each product? • Self-Starter? • Ability to work overtime as required? • Ability to work a flexible schedule including weekends? Minimum Qualifications:? • High school education or equivalent? • 2 years of work experience in an office environment, healthcare related/insurance related field or customer service industry? • Prior experience working on a computer? • Problem solving skills? • Self -Starter and detail oriented? 1. Work address 11000 Optum Circle Eden Prairie, MN 55344? 2. Face to face interviewing? 3. Work hours - M-F 8am -4:30pm? Business casual dress code Dress Code: Casual ?IMPORTANT:? This position is being recruited for by Adecco's National Recruitment Center, not your local Adecco Branch Office. To be considered for this position, you must use the "apply now" button to submit your resume. If you have questions about the position, you may contact the recruiter recruiting for this position listed above. For other opportunities available at Adecco go to? www.adeccousa.com . ? ? If you have any questions surrounding the application process, please feel free to reach out to Yulia Le Good,? Yulia.legoodadeccona.com , tel. 631-844-2804 ? The Adecco Group is a global leader in HR services.? Our group connects over 700,000 associates with our business clients each day through our 6,600 offices in over 70 countries and territories around the world.? We offer employment opportunities at any stage in your professional career.? Contact us today to discuss available contract and direct hire positions.? Adecco Group provides one of the most comprehensive benefits packages in the industry to contract workers to include Holiday, 401(k) and Insurance Benefit Plans. Equal Opportunity Employer Minorities/Women/Veterans/Disabled ? Company Description: Adecco is the world’s largest provider of staffing solutions. But it’s not our size that makes us different, it’s our unwavering commitment to the businesses, job seekers and communities we serve. Every day, we propel job seekers forward in their career and help America’s top employers attract, develop and manage the very best talent. Job seekers rely on us for exciting temporary, temp-to-perm and permanent opportunities, as well as career resources and advice. Businesses throughout the country and across all industries count on us for access to more than 9 million qualified candidates and an ability to deliver proactive and actionable insight into the economy and the job market. We also sponsor community and nationwide community service events to ensure opportunities for all. We are proud of the fact that we connect more people with more jobs than anyone else, and know how important what we do is - not only to the economy and job market, but also to the lives and communities we touch

jobs byAdzuna

COMPLIANCE SPECIALIST - PROFESSIONAL

5 days ago
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Auto req ID 105084BR Duke Entity PRMO Job Code 4557 COMPLIANCE SPECIALIST Job Description General Description of the Job Class Implement and maintain Coding Compliance programs in accordance with the Office of Inspector General's work plan, to reduce institutional and individual provider legal and financial risk through internal audits, training and education. Additionally increase revenue, accuracy of payment and quality of care with improved documentation by identifying, training/educating, capturing and submitting valid medical diagnosis Duties and Responsibilities of this Level 70% • Thorough understanding of clinic coding (E/M) documentation requirements and HCC concepts impacting population Health Risk Adjustment reimbursement initiatives • Ability to review documentation and abstract all codes with specific emphasis on identifying the most accurate severity of illness according to CMS HCC guidelines o Leverage Healthcare Effectiveness Data and Information Set (HEDIS) to measure provider performance on important aspects of care and service o Collaborate with CDI Representative to provide timely feedback that will assist with validating and reporting appropriate measures of accuracy • Offers recommendations and develops templates and tips for capturing the HCCs at the patient encounter • Serve as HCC subject matter expert in conjunction with CDIS program lead(s) to providers, practice managers, PRMO leadership, and Duke Health stakeholders • Coordinate activities related to Coding Quality Assurance/Audit. Be actively engaged in coding, abstracting and medical data research to include review and analysis of data input, processing and data output activities. o Develop and present educational training programs to hospital and medical coding staff, and maintaining educational collaborations such as Bulletin Review from Payers and review of coding queries. • Conducts both random and focused reviews on a regularly scheduled timeframe for accurate documentation and coding which is then reported to coding operations. • Identifies coding and billing risk areas and communicates timely through the appropriate channels/forums those areas that require escalation. • Collaborates with internal staff in development of improved capabilities in coding and compliance. • Responds promptly to external and internal concerns with regard to correct coding policies. Identifies errors on claims and sends to the Claim Correction Department for processing. • Assists with education of providers in regard to compliance and government regulations with special attention to CMS and Medicaid guidelines as they pertain to academic medical centers, HIPAA, and Fraud and Abuse with periodic updates. • Maintains knowledge regarding policies and procedures with Medicare/Medicaid Carriers and third party payers; including HCC and RAF guidelines • Collaborates with Internal Compliance Department to promote excellence in correct documentation and coding. • Interacts effectively and professionally with colleagues to provide helpful information in response to inquiries, concerns and requests. • Develops and maintains strong working relationships with both internal and external customers. 20% • Provides documented education ( e.g. PPT, handouts, training materials, etc. to be posted to the Quality Audit/Review Share Point). • Presents 4 – 7 education sessions each year with evaluations • Assists in the financial goals of the department through individual efforts as well as encouraging excellence in others via collaboration. • Adheres to all internal policies. • Actively promotes a better DUHS work environment and a positive atmosphere in which to work. • Exemplifies DUHS core values and encourages othersto follow this high standard. • Shows respect and values others at all times. • Participates in multiple employee engagements that align with covenant mission 10% • Performs other duties as assigned by management Perform other related duties incidental to the work described herein: • Maintains all coding credentialing for I-10, HCC and other training and education. • May participate in payer testing • May work with HLI staff and DUHS IT staff to provide data analysis • May work collaboratively with IMO/MC teams to identify critical language/coding needs. • Anticipates needs of DUHS regarding I-10/I11 data analytics, preference list and mappings/crosswalks CPC, abstraction, CPMA, professional billing Location Durham Requisition Number 401494592 Position Title COMPLIANCE SPECIALIST - PROFESSIONAL Shift First/Day Job Family Level F2 Full Time / Part Time FULL TIME Regular / Temporary Regular Department Name CODING INTEGRITY PROFESSIONAL Minimum Qualifications Duke University is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status. Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values. Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department. Education Work requires organization, analytical and communication skills generally acquired through the completion of a Bachelor's degree program. Experience Four years of administrative experience to acquire competence in applying compliance, coding and auditing principles as they relate to insurance billing, collections, consulting, and other revenue cycle related functions. For professional coding, specialty coding experience in surgical or E/M coding preferred. CPC or CPMA is required. Liscensure and/or Certifications CPMA certification strongly preferred, if not already acquired, and must obtain with 6 months.

jobs byAdzuna

Statistician - Healthcare

14 days ago
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…benefits packages, but the opportunity to create a meaningful impact in jobs and on projects that matter. Perspecta's talented and robust workforce-14,000

jobs byJuju.com

VP Dental Clinical Operations - UHC

21 days ago
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…issue provider report cards, recover funds as appropriate, and refer suspected fraud and abuse for action. Maintenance of Quality Management Program, Quality

jobs byJuju.com

Pharmacy Director Full-Time - Hospital

28 days ago
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Soliant Health has partnered with a leader in health care in Southern California and seeking a ... real or potential fraud or abuse according to Compliance Code of Conduct. JOB RELATIONSHIPS

jobs byZipRecruiter

Internal Medicine Physician General Internist - Physicians Only Apply - Perm

2 months ago
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…is seeking a qualified physician for Columbia, SC. This and other physician jobs brought to you by ExactMD. Chief Medical Director Position Purpose: Direct and

jobs byJuju.com

Controller (Healthcare)

2 months ago
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... fraud, and/or abuse. -Oversees revisions or modifications relating to Accounting Information ... care. · Ability to create & build relationships and effectively deal with people of all levels ...

jobs byZipRecruiter

IT Security Analyst

2 months ago
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Vera Whole Health is transforming healthcare. For insurers and employers alike, Vera helps take ... Recognize opportunities for addressing fraud issues, risks, and exposures. * Collaborate with cross ...

jobs byZipRecruiter

Counsel - US Pricing & Access, Commercial Legal

2 months ago
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…other things: + Provide guidance to the company's US commercial organization on healthcare fraud and abuse risks when interacting and/or contracting with

jobs byJuju.com

Corporate SIU Auditor

2 months ago
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This role will detect, investigate, remediate and refer to law enforcement as appropriate incidents of provider fraud, waste and abuse arising in connection with healthcare services. Responsible for ...

jobs byZipRecruiter

RN Utilization Review

3 months ago
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Ensures appropriate and cost-effective healthcare services to patients. * Analyzes patient records ... Recognizes and reports appropriately cases of fraud, abuse or mis-utilization * Consults with ...

jobs byZipRecruiter

Compliance Analyst

5 months ago
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Familiar with required laws pertaining to HIPPA Security & Privacy, Fraud Waste and Abuse * Knowledge of health plans, medical groups, and managed care operations and related functions and ...

jobs byZipRecruiter

Health Care Associate Attorney

8 months ago
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Job ID: 152961 New York City office of an AmLaw firm seeks healthcare corporate associate attorney with 2-5 years of fraud and abuse experience. The candidate should have compliance and healthcare ...

jobs byZipRecruiter

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