SIU case investigation management and resolution: Manage FWA case investigations, collaborate with federal, state and law enforcement entities, and provide applicable notifications as required. Maintain extensive documentation and evidence for SIU cases. Recommend and implement preventive measures to combat FWA. schemes including, but not limited to provider education, policies, claims edits and payment suspensions. Manage the recovery, allocation and documentation of health plan funds resulting from FWA findings. SIU allegation intake and management: Manage the intake, documentation and resolution of FWA referrals to SIU. Coordinate with internal and external partners on FWA allegations. Assess needs, make recommendations and complete timely reviews in accordance with all regulatory requirements. Support SIU Operations: Create and maintain internal policies and procedures, workflows and presentations and present as needed to internal and external entities. Support regulatory audits and RFIs from law enforcement and federal and state entities. Represent SIU at cross functional workgroups and meetings and present case recommendations to other applicable business areas including, but not limited to Legal, Medical Management, Provider Operations and Claims Administration. Perform all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid
...Description Job Description Bach To Rock (B2R) Americas Music School for students of all ages is currently seeking a Music Teacher... ...music should be fun! Position Responsibilities: Teach private and semi-private lessons using Bach to Rock curriculum and...
...Personal Assistant Location: Tampa, Florida Full-time | Monday-Friday Overview: Robert Half is seeking a detail-oriented and organized individual with a proven track record in Personal Assistant processes for a well-established company in the Tampa Bay area...
HCA Healthcare is actively seeking a dedicated Registered Nurse (RN) to fill a per diem position in our Post-Anesthesia Care Unit (PACU). As a PRN RN at HCA Healthcare, you'll play a critical role in providing compassionate post-operative care to patients. Our network,...
Description: At ABC Home & Commercial Services, were more than just a company; were a family committed to excellence. With 75 years of history and a team of over 1,000 employees serving a growing network of cities in Central and South Texas, we take pride in being a family...
We are supporting a confidential search for a Chief Risk Officer to join a midsized financial services wealth management firm with a strong regulatory and fiduciary culture. This is a senior executive role with direct responsibility for shaping and leading the firms...