Senior Fraud, Waste and Abuse (FWA) Specialist PacificSource Health PlansSenior Fraud, Waste and Abuse (FWA) SpecialistVA$65,296.83–$111,004.62 / yearThis position leads program administration activities, partners with operational teams and regulatory agencies, and develops processes that strengthen the organization''s ability to detect, prevent, investigate, recover, and report fraud, waste, abuse, and payment integrity concerns. The Senior Fraud, Waste and Abuse (FWA) Specialist serves as the organization's subject matter expert responsible for supporting and advancing PacificSource''s Payment Integrity and FWA programs.
Referral Management Reviewers (Bethesda, MD) Ivyhill Technologies LLCReferral Management Reviewers (Bethesda, MD)Bethesda, MDCollaborates with appointing center, case managers, product line nurses, providers, clinics, manage care support contractor liaison and other members of the healthcare team as needed to ensure proper use of Direct Care system and civilian network resources, as well as to ensure that patients are booked at the right time, with the right provider, at the right place. Team Ivyhill is currently seeking to hire Referral Management (Non-Nurse) Reviewers to support its contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Regions’ premier coordinating authority for appointing and referral management services for beneficiaries in the Defense Health Network.
Java Developer Kasmo IncJava DeveloperHerndon, VARemoteDescription: · Designs, develops documents, tests and debugs new and existing software systems and/or applications. · Provides estimates, budgets, project flow, client updates and meeting expectations along with keeping up to team aspirations.
Network Contract Manager / Dental Recruiter - East Region - Remote UnitedHealth Group Inc.Network Contract Manager / Dental Recruiter - East Region - RemoteWashington, DCRemote$72,800–$130,000 / yearThe Dental Network Contractor develops the provider network yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management, and produces an affordable and predictable product for customers and business partners. Responsibilities also include establishing and maintaining solid business relationships with the providers in the network and ensuring the network composition includes an appropriate distribution of provider specialties.
General Liability Property Damage Adjuster - Washington DC/Baltimore Engle Martin & Associates, Inc.General Liability Property Damage Adjuster - Washington DC/BaltimoreWashington, DCYour EMpact: Determine appropriate methods and extent of needed investigation for all assigned claims, including conducting investigations through field visits and phone contact; obtaining contracts, job files, and appraisals; conducting insured, witness, and claimant interviews and/or statements, complete site inspections; scope, measure and write estimates, and using other fact-finding methods to evaluate liability, damages, and proper coverage. Investigate insurance claims in a variety of settings including, but not limited to: retail establishments, office buildings, residences, condominiums, apartments, hotels, corporate facilities, governmental facilities, schools, clinics, or hospitals; assess loss or damage resulting from various events including, but not limited to, inclement or catastrophic weather, construction defect, and fire.
CBO EDI Associate MedVanta CareersCBO EDI AssociateBethesda, MarylandThrough a combination of innovative technology, clinical expertise, data-driven insights, and care navigation services, MedVanta delivers solutions that support prevention, performance, treatment, recovery, and long-term musculoskeletal health. MedVanta is the nation's largest physician-owned musculoskeletal (MSK) platform, dedicated to helping individuals prevent injuries, improve movement, recover from musculoskeletal conditions, and access high-quality MSK care.
CBO EDI Associate MedVanta Interco, LLC.CBO EDI AssociateBethesda, MD$18 / hourPart timeThrough a combination of innovative technology, clinical expertise, data-driven insights, and care navigation services, MedVanta delivers solutions that support prevention, performance, treatment, recovery, and long-term musculoskeletal health. MedVanta is the nation's largest physician-owned musculoskeletal (MSK) platform, dedicated to helping individuals prevent injuries, improve movement, recover from musculoskeletal conditions, and access high-quality MSK care.
NewField Auto Adjuster - Springfield, VA Allstate Insurance CompanyField Auto Adjuster - Springfield, VASpringfield, VA$60,000–$117,700 / yearThis role offers a sign on bonus of $1,000 if you have an active appraiser license or active adjuster license in TX, FL, or your resident state (current employees and candidates who have previously worked for and are seeking to be rehired at Allstate and its family of companies are not eligible for this sign-on bonus). No two days are the same-whether you're evaluating damage on-site or collaborating with body shops and service providers, you'll enjoy a fast-paced, hands-on role that keeps you engaged and on your toes.
BILLING SPECIALIST Universal Home Health Care LlcBILLING SPECIALISTCheverly, MDFull timeThis position will work closely with the administrative team to verify service documentation, identify billing discrepancies, track outstanding claims, and maintain accurate billing records. High school diploma or equivalent required; Associate’s or Bachelor’s degree in Accounting, Finance, Healthcare Administration, or a related field preferred.
NewData Scientist SteerBridgeData ScientistVienna, Virginia$137,000–$155,000 / yearThis role independently owns analytical projects from problem framing through model deployment, applying statistical modeling and machine learning to claims and healthcare data in support of VA disability claims processing. We don’t simply hire exceptional talent; we cultivate it , creating meaningful career pathways for veterans, military spouses, and professionals who share our passion for advancing technology and strengthening the missions we serve.
Director - State Insurance Program (EXECUTIVE VII) State of MarylandDirector - State Insurance Program (EXECUTIVE VII)MDThe Directorâs role is to unequivocally support the vision and goals of the Chief Deputy Treasurer and Treasurer in carrying out the Divisionâs mission: to act as a steward for the State Insurance Trust Fund, to procure all of the Stateâs 55+ commercial insurance programs in order to protect the Trust Fund from catastrophic loss, to ensure compliance with State laws and regulations, to provide oversight on loss control and litigation, and to ensure proper oversight of the Divisionâs Claims Unit matters. The Divisionâs goal is to provide statewide risk management through loss protection (Underwriting), loss control (Loss Prevention), loss restoration (Claims & Tort Litigation), and contract administration and advocacy for State employee injury coverage (Workersâ Compensation).Â
NewSenior Fraud and Abuse Investigator/CPC/CFI/CFS/CHC/CFE/AHFI - Remote Sentara Healthcare IncSenior Fraud and Abuse Investigator/CPC/CFI/CFS/CHC/CFE/AHFI - RemoteVARemote$25.60–$42.67 / hourExperience utilizing data analytics to identify high-risk providers and claims for pre-payment review within a healthcare payer, SIU, Program Integrity, or Payment Integrity environment is strongly preferred. Experience conducting pre-pay investigations, provider risk assessments, data mining, fraud, waste and abuse (FWA) analysis, and proactive identification of billing anomalies and emerging provider trends.
Referral Management (Non-Nurse) Reviewer Zimmerman Associates IncReferral Management (Non-Nurse) ReviewerBethesda, MDEssential Tasks: Review and process referrals for administrative and clinical completeness and appropriateness, completing disposition within 24 hours of referral date Collaborate with appointing centers, case managers, product line nurses, providers, clinics, managed care contractors, and other healthcare team members to ensure appropriate use of Direct Care and civilian network resources Ensure patients are scheduled with the right provider, at the right time and place Review compliance with Specialty Referral Guidelines (SRGs) per IRMAC protocols Complete and return Clear Legible Reports (CLR) to ordering civilian providers within required Return of Favorable Response (ROFR) timelines Manage telephone, written, and electronic communications regarding specialty appointments and referrals Monitor and process referral management worklists (e.g., Genesis Work Lists) to ensure timely consult processing Communicate referral status to patients, including benefit counseling and advocacy resources as needed Reschedule or redirect patients within 3 days when referrals are disapproved or invalid, advising on other care options and Line-of-Duty issues Receive and enter ROFR referrals in MHS-GENESIS from Military Contractor Support Centers (MCSC) portals for assigned specialties/product lines, adhering to all timelines and business rules Verify patient eligibility and update demographics in MHS-GENESIS Document patient interactions, especially when appointments are refused, and coordinate with Beneficiary Counselor and Assistance Coordinator as appropriate Coordinate with product line nurses and clinics for special accommodations Interface with MCSC and multidisciplinary teams to ensure referral appropriateness Submit referrals to non-network providers for TRICARE Service Center medical necessity reviews Monitor referral management voicemail and return patient calls within established guidelines Provide External Provider Referral Online (EPRO) information as requested Close unused referrals following DHA IPM and NCR Medical Directorate policies, notifying ordering providers accordingly Orient and train new IRMAC staff on referral processes and timelines Perform other duties as assigned. Zimmerman Associates, Inc. (ZAI) is seeking to hire multiple Referral Management (Non-Nurse) Reviewers to support our contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Region's premier authority for appointment coordination and referral management services for beneficiaries within the Defense Health Network.
Field Reimbursement Manager, Market Access - Mid-Atlantic Region GE HealthCare Technologies IncField Reimbursement Manager, Market Access - Mid-Atlantic RegionVA$132,000–$198,000 / yearThe Field Reimbursement Manager (FRM) is a customer-facing access & reimbursement subject matter expert who provides education, support center integration and patient level issue resolution across the Pharmaceutical Diagnostic (PDx) portfolio. The FRM will create value through education, procedural efficiency through in supporting the determination of benefits and reimbursement and embedding GEHC's world class support center within customers' practices and/or health systems.
Dental Receptionist/Dental Assistant Lorton Valley Dental PLLcDental Receptionist/Dental AssistantLorton, Virginia$17–$23Lorton Valley Dental in Lorton VA is seeking a Dental Receptionist/ Dental Assistant to join our team 4 days/per week with the salary ranging from $17 to $23. Dental Assistant: Preparing patients for dental procedures.
Retirement Plan Operations Specialist Guidant FinancialRetirement Plan Operations SpecialistAlexandria, VARemote1 to 5 years of adjacent back-office financial operations experience in one or more of the following areas: benefits administration, money movement and wires, insurance claims processing, tax prep processing, loan or mortgage document processing, or compliance or quality-control support. You’ll review documents submitted by our clients, proactively keep clients updated on progress and help clients understand the year-end reporting documents necessary to complete government filings, including the annual 5500 return.
QA Engineer - DM platform (Remote) - Blue Bell, PA AHU TechnologiesQA Engineer - DM platform (Remote) - Blue Bell, PAWashington, District of ColumbiaRemoteThey are responsible for utilizing internal data sources to perform in-depth research and analysis on client data inquiries, execute a varying level of implementation functions such as testing new file extracts, provide defect and enhancement support to development and product teams. Job Description: Looking for a mid level QA Testing Job Requirements - QA Engineers Overall qualifications : •Bamboo, and Github experience required •Cucumber-TestNG framework using JAVA, Selenium, RestAssured, Maven for UI and API Automation Testing experience preferred.
Paralegal AmentumParalegalWashingtonIn accordance with the Health and Welfare provisions of the SCA, and in addition to your base hourly rate, you may be eligible to receive an additional health and welfare payment for each hour you work to ensure compliance with the minimums set forth by the act. Ensure all incoming correspondence reviewed for completeness ensuring file documents match claimant and Personally Identifiable Information (PII) compliance prior to CMS upload.
ParalegaI AmentumParalegaIWashingtonIn accordance with the Health and Welfare provisions of the SCA, and in addition to your base hourly rate, you may be eligible to receive an additional health and welfare payment for each hour you work to ensure compliance with the minimums set forth by the act. Ensure all incoming correspondence reviewed for completeness ensuring file documents match claimant and Personally Identifiable Information (PII) compliance prior to CMS upload.
Portfolio Operations Analyst ProSharesPortfolio Operations AnalystBethesda, MDComplete the processing, research and collection of all corporate action related activity including, but not limited to: Cash Dividends, Stock Dividends, Stock Splits, Spin Offs, Cash & Stock Mergers, Tender Offers, Rights Subscriptions, Full & Partial Calls, and Maturities. Rare opportunity to develop expertise across virtually every major asset class—including ETFs, mutual funds, swaps, futures, options, fixed income, equities, repo, and global markets—rather than specializing in a single product area.