Lead SIU Investigator Centene Corporation GroupLead SIU InvestigatorCORemote$70,100–$126,200 / yearEducation/Experience: Bachelor's Degree in related field; or Associate's degree with 6 years related experience; or High School Diploma/GED with 7 years related experience. Provides direction and guidance to staff who investigate and remediate compliance and fraud, waste, and abuse related matters; while maintaining an investigative workload of moderate to high complexity.
NewSIU Investigator Centene Corporation GroupSIU InvestigatorCO$56,200–$101,000 / yearLicenses/Certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), or other related investigative, auditing, or compliance certification preferred. Collaborates with internal business partners, compliance, legal, provider and payment integrity teams, and external agencies to coordinate investigative activities, support corrective actions, recoveries, and case resolution efforts.
Surveillance Investigator Allied UniversalSurveillance InvestigatorDenver, Colorado$20–$24 / hourThe Surveillance Investigator will perform discreet mobile and stationary surveillance of a Claimant to confirm current activities and capabilities to assist with the administration of an insurance claim. Conduct independent investigations of insurance claims across a range of coverage types, including workers’ compensation, general liability, property and casualty, and disability .
Investigator II Elevance HealthInvestigator IIDenver, ColoradoWe are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance.
POST Certified Senior Criminal Investigator (Economics Crimes Unit) City and County of DenverPOST Certified Senior Criminal Investigator (Economics Crimes Unit)Denver, ColoradoThe Mission of the Denver District Attorney's Office is to professionally and completely prosecute crimes and investigate potential crimes on behalf of the people of the State of Colorado, and in doing so, do justice, advocate for victims' rights and advise and consult in the deterrence and prevention of crime; to ensure the open, evenhanded and humane administration of justice. Determines investigative techniques and case strategies; gathers, evaluates, and preserves evidence, analyzes the evidence, prepares spreadsheets or summary charts on financial or voluminous data, prepares diagrams and demonstrative evidence, photograph crime scenes and determines the presence or absence of criminal activity.
Program Integrity Investigator TriWest Healthcare AllianceProgram Integrity InvestigatorDenver, CORemoteFull timeComplies with the Veterans Affairs Community Care Network (CCN) and TRICARE T-5 contracts; DHA and TRICARE program guidelines and pertinent Federal regulatory requirements; assists supervisors with FWA trending and reporting requirements; coordinates and assists with investigations and prosecutions by federal agencies interfaces directly with Veterans, Military members and family (as warranted), providers, subcontractors, and other TriWest departments on FWA issues; assist supervisor with the education and training of TriWest, subcontractor, and provider personnel on current FWA matters; prepares appropriate responses to provider compliance issues and complaints referred to Program Integrity by other TriWest departments or external referrals. The PI Investigator t is responsible for the identification, analysis, case development, and reporting of suspected fraud, waste and abuse (FWA) cases as defined by the Department of Veterans Affairs (VA), the Healthcare Finance Administration (HCFA) and the Department of Defense, Defense Health Agency for the TRICARE program; requests and reviews issue-related medical claims and records for FWA and/or administrative and clerical error(s).
Employment Investigator DaVita Inc.Employment InvestigatorDenver, CO$78,000–$119,000 / yearThis position is responsible for working directly on teammate issues to resolve matters of significance on behalf of management, including investigating and responding to internal and external complaints, and handling other complex, high-risk, or sensitive Teammate Relations (TMR) matters. Professional development programs: DaVita offers a variety of programs to help strong performers grow within their career and also offers on-demand virtual leadership and development courses through DaVita's online training platform StarLearning.
Senior Compliance Investigator Centene Corporation GroupSenior Compliance InvestigatorCO$70,100–$126,200 / yearLeads and conducts compliance and ethics investigations across all business units and health plans, including but not limited to assessment of allegations, review of relevant documents, witness interviews, analysis of facts, root cause analysis, and preparation of investigation reports with recommended remedial or disciplinary actions. Education/Experience: A Bachelor's Degree in Related Field or Associates with 5 years of applicable experience, or a High School/GED with 6 years of applicable experience may substitute for the Bachelor's Degree, required.
NewCollections Specialist AtriumCollections SpecialistBoston, MA$37–$42 / hourThis Collections Specialist is responsible for managing collections activities, analyzing accounts receivable, resolving billing issues, and supporting attorneys and clients throughout the collections process. Additional benefits may include accident insurance, supplemental life insurance, disability insurance, critical illness and cancer insurance, pet insurance, and commuter/transit programs where available.
Phlebotomist / Administrative Assistant Kendall Square One Medical of NY, PCPhlebotomist / Administrative Assistant Kendall SquareCambridge, MA$24–$26 / hourWhat you'll likely work on: Use impeccable C-I-CARE (a framework containing the key elements of a great interaction and effective communication that we use with patients and each other) in all patient interactions, both clinical and administrative, and ensure a fluid and positive in-office experience through patient intake, same day schedule management, appropriate follow up scheduling, strong knowledge of billing and insurance, monitoring patient feedback and assisting with outreach as necessary. As a One Medical Phlebotomist/Administrative Assistant (internally known as Lab Services Specialist/Member Support Specialist) at one of our offices, you'll provide an exceptional experience for our patients and help them accomplish an important part of their care journey by providing venipuncture as well as other clinical support services.
NewPharmacy Benefit Verification Specialist Onco360Pharmacy Benefit Verification SpecialistWaltham, MassachusettsSkills/Knowledge: Required: Pharmacy insurance and benefit verification, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills. Pharmacy Benefit Verification Summary The Benefit Verification Specialist will investigate, review, and load accurate patient insurances, including medical and pharmacy coverage, assign coordination of benefits, run test claims to obtain a valid insurance response on patient medications, investigate/identify authorization requirements needed to obtain medication coverage, and enroll eligible patients in copay card assistance programs.
Senior Specialist (Manager), Order Management Systems and Processes Lantheus Holdings IncSenior Specialist (Manager), Order Management Systems and ProcessesBedford, MA$111,000–$185,000 / yearReporting to the Director of Commercial Order Management Systems, this role partners cross-functionally to deliver process improvements, support and implement system enhancements, and maintain operational stability across OTC workflows. Lantheus (NASDAQ: LNTH) is the leading radiopharmaceutical-focused company, delivering life-changing science to enable clinicians to Find, Fight and Follow disease to deliver better patient outcomes.
Senior Patient Financial Services Specialist Hebrew Rehabilitation CenterSenior Patient Financial Services SpecialistDedham, MassachusettsThis role requires specialized expertise in Massachusetts Medicaid (MassHealth), including application, renewal, and compliance processes, as well as a strong understanding of reimbursement models for custodial care, skilled nursing facilities (SNF), and managed care programs. The ideal candidate will serve as a key liaison between patients, families, clinical teams, admissions, MassHealth and payers to ensure timely coverage, guarantor education, and financial compliance.
Senior Patient Financial Services Specialist Per Diem Hebrew Senior LifeSenior Patient Financial Services Specialist Per DiemRoslindale, MA$54,022.04–$81,033.59 / yearThis role requires specialized expertise in Massachusetts Medicaid (MassHealth), including application, renewal, and compliance processes, as well as a strong understanding of reimbursement models for custodial care, skilled nursing facilities (SNF), and managed care programs. The ideal candidate will serve as a key liaison between patients, families, clinical teams, admissions, MassHealth and payers to ensure timely coverage, guarantor education, and financial compliance.
Senior Patient Financial Services Specialist Per Diem Hebrew Rehabilitation CenterSenior Patient Financial Services Specialist Per DiemDedham, MassachusettsThis role requires specialized expertise in Massachusetts Medicaid (MassHealth), including application, renewal, and compliance processes, as well as a strong understanding of reimbursement models for custodial care, skilled nursing facilities (SNF), and managed care programs. The ideal candidate will serve as a key liaison between patients, families, clinical teams, admissions, MassHealth and payers to ensure timely coverage, guarantor education, and financial compliance.
Senior Patient Financial Services Specialist Hebrew Senior LifeSenior Patient Financial Services SpecialistDedham, MA$54,022.04–$81,033.59 / yearThis role requires specialized expertise in Massachusetts Medicaid (MassHealth), including application, renewal, and compliance processes, as well as a strong understanding of reimbursement models for custodial care, skilled nursing facilities (SNF), and managed care programs. The ideal candidate will serve as a key liaison between patients, families, clinical teams, admissions, MassHealth and payers to ensure timely coverage, guarantor education, and financial compliance.
NewPharmacy Claims Adjudication Specialist Onco360Pharmacy Claims Adjudication SpecialistWaltham, MassachusettsSkills/Knowledge Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections Pharmacy Adjudication Specialists at Onco360.
Client Relations Specialist LaBovick Law GroupClient Relations SpecialistQuincy, MassachusettsJoin our growing PIP (Personal Injury Protection) team as a Client Support Specialist , where you’ll play an important role in helping our medical provider clients obtain timely payment from insurance carriers for services rendered under the PIP statute. This position offers a great balance of remote work and travel —you’ll spend approximately 40% of your time visiting client sites , cultivating relationships, and ensuring documentation accuracy.
Claims Review Specialist, Dsnp Brigham and Women's HospitalClaims Review Specialist, DsnpSomerville, MARemote$17.71–$25.28 / hourWorking with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success.
Inpatient Coding Quality Specialist Brigham and Women's HospitalInpatient Coding Quality SpecialistSomerville, MA$30.60–$44.51 / hourEnsure coding practices align with official coding conventions, guidelines, and regulatory requirements set forth by organizations such as the American Medical Association (AMA), Centers for Medicare and Medicaid Services (CMS), and other relevant bodies. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success.