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Job DescriptionHealthcare Fraud Investigator Employment Type: Full-Time, Mid-Level Department: Litigation Support CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Nashville, TN. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pressure, and be enthusiastic about learning and applying knowledge to provide excellent litigation support to the client. CGS brings motivated, highly skilled, and creative people together to solve the government’s most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities. Responsibilities will Include:- Review, sort, and analyze data using computer software programs such as Microsoft Excel.- Review financial records, complex legal and regulatory documents and summarize contents, and conduct research as needed. Preparing spreadsheets of financial transactions (e.g., check spreads, etc.).- Develop HCF case referrals including, but not limited to:- Ensure that HCF referrals meet agency and USAO standards for litigation.- Analyze data for evidence of fraud, waste and abuse.- Review and evaluate referrals to determine the need for additional information and evidence, and plan comprehensive approach to obtain this information and evidence.- Advise the HCF attorney(s) regarding the merits and weaknesses of HCF referrals based upon applicable law, evidence of liability and damages, and potential defenses, and recommend for or against commencement of judicial proceedings.- Assist the USAO develop new referrals by ensuring a good working relationship with client agencies and the public, and by assisting in HCF training for federal, state and local agencies, preparing informational literature, etc. - Assist conducting witness interviews and preparing written summaries. Qualifications:- Four (4) year undergraduate degree or higher in criminal justice, finance, project management, or other related field.- Minimum three (3) years of professional work experience in healthcare, fraud, or other related investigative field of work.- Proficiency in Microsoft Office applications including Outlook, Word, Excel, PowerPoint, etc.- Proficiency in analyzing data that would assist in providing specific case support to the Government in civil HCF matters (E.g., Medicare data, Medicaid data, outlier data).- Communication skills: Ability to interact professionally and effectively with all levels of staff including AUSAs, support staff, client agencies, debtors, debtor attorneys and their staff, court personnel, business executives, witnesses, and the public. Communication requires tact and diplomacy.- U.S. Citizenship and ability to obtain adjudication for the requisite background investigation.- Experience and expertise in performing the requisite services in Section 3.- Must be a US Citizen.- Must be able to obtain a favorably adjudicated Public Trust Clearance.Preferred qualifications:- Relevant Healthcare Fraud experience including compliance, auditing duties, and other duties in Section 3.- Relevant experience working with a federal or state legal or law enforcement entity. #CJ We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

Job Description Hi, we're Oscar. We're hiring a SIU Coding Auditor to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role The Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations. You will report to the Manager, SIU Coding Audit. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. Pay Transparency: The base pay for this role in the states of New Jersey and New York is: $65,412 - $85,853 per year. The base pay for this role is: $58,870 - $77,267 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities • Develop a depth of expertise on CPT, HCPCS, and ICD-10 Coding guidelines and other insurance billing submission requirements., • Perform complex audits of assigned medical records and claims on both a prepayment and post payment basis to determine accuracy of claims submitted to Oscar., • Document findings including reference to sources used to support decision making and in a way that can be easily understood by non clinicians or coders., • Create audit report findings, tools, and reference guide that can be used by other team members to communicate findings or more effectively perform similar reviews., • Help draft written communications to providers to convey audit findings., • Participate in educational calls with providers., • Help train new team members., • Develop and document processes to improve the effectiveness of the team., • Compliance with all applicable laws and regulations, • Other duties as assignedQualifications, • 2+ years of coding or auditing experience across multiple specialties is required, • Bachelor's degree or 4+ years of work experience, • Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC) designation or similar certification, • Experience working in production-based environment, • Experience of both outpatient and inpatient auditingBonus Points, • Certified Professional Medical Auditor (CPMA), • Additional certification applicable to this work such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), other coding certifications or similar, • Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity, • Demonstrated experience translating technical jargon to non-technical end users., • Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting., • Experience with HIPAA, data privacy, and/or data security processes, • Experience working with regulators governing (public or private) health insurance carriers This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

A leading health organization seeks an investigator for healthcare fraud allegations.Responsibilities include conducting investigations, analyzing claims data, and preparing reports.A bachelor's degree and 1+ years in medical claim analysis are essential.Preferred candidates will have a minimum of 5

A governmental support organization is seeking a Healthcare Fraud Investigator to provide legal support for a large government project in Nashville, TN. The role involves analyzing data for fraud and assisting legal teams in investigations.

CGS is seeking a Healthcare Fraud Investigator to provide legal support for a large government project in Nashville, TN. Minimum three (3) years of professional work experience in healthcare, fraud, or other related investigative field of work. Relevant healthcare fraud experience including complian

Certified Professional Coder (CPC), Accredited Healthcare Fraud Investigator (AFHI), Certified Insurance Fraud Investigator (CIFI), and/or Certified Economic Crime Forensic Examiner (CECFE) preferred (but not required). Conducts investigations into allegations of fraud, waste, or abuse, including pr

CGS is seeking a Healthcare Fraud Investigator to provide legal support for a large government project in Nashville, TN. Analyze data for evidence of fraud, waste, and abuse. Minimum three (3) years of professional work experience in healthcare, fraud, or other related investigative field of work.

Certified Professional Coder (CPC), Accredited Healthcare Fraud Investigator (AFHI), Certified Insurance Fraud Investigator (CIFI), and/or Certified Economic Crime Forensic Examiner (CECFE) preferred (but not required). Conducts investigations into allegations of fraud, waste, or abuse, including pr

Job Description Registered Nurse - Nursing Home Surveyor/Complaint Investigator - New York, NY (#6045A) • Location: New York City, NY – Bronx, Kings, Richmond, Manhattan, and Queens, • Employment Type: Temporary-to-permanent, • Hourly Rate: $60 per hour About Greenlife Healthcare Staffing: Greenlife Healthcare Staffing is a leading nationwide recruitment agency dedicated to connecting healthcare professionals with top-tier opportunities. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals. Position Overview: We are seeking a dedicated and experienced Registered Nurse - Nursing Home Surveyor/Complaint Investigator to join our team in New York City, NY (Bronx, Kings, Richmond, Manhattan, and Queens). This role is a temporary-to-permanent position that involves conducting surveys, complaint investigations, and surveillance activities at nursing homes to ensure compliance with Federal and State regulations. Why Join Us? • Competitive Compensation: Earn $60/hr with mileage reimbursement., • Flexibility: Enjoy a flexible schedule and the opportunity to work a temporary-to-permanent position., • Professional Growth: Gain valuable experience in a collaborative, innovative, and supportive environment., • Impactful Work: Contribute to a mission-driven organization dedicated to improving patient outcomes. Qualifications: • Education: Bachelor’s degree in Nursing., • Licensure: Must hold an active NYS Registered Nurse license., • Experience:, • Minimum of 2 years of experience in utilization review, claims adjudication, medical review, fraud investigation, surveillance, or monitoring activities; OR, • 3 years of clinical or administrative experience; OR, • A Bachelor’s degree in Nursing and 2 years of clinical or administrative experience., • At least 1 year of survey experience is required., • Technical Skills: Strong computer skills with the ability to learn new programs., • Soft Skills: Strong attention to detail, excellent interpersonal and communication skills, superior investigative and analytical abilities. Can work independently and as part of a team., • Additional Requirements:, • SMQT Certification is preferred but must be obtained within 12 months of employment., • Must have a valid driver’s license and the ability to travel to on-site facilities. Key Responsibilities: • Participate in surveys and complaint investigations, including allegations of abuse and neglect, at nursing homes (long-term care facilities)., • Produce written documentation and draft Statements of Deficiencies (SOD) within required timeframes using Principles of Documentation., • Assess compliance with Plans of Correction within required timeframes., • Complete data entry in federal and state reporting databases as required., • Participate in state monitoring during immediate jeopardy situations., • Attend meetings and testify in administrative hearings as needed., • Adhere to DOH work schedules, policies, and procedures., • Travel to onsite locations according to the work schedule. Greenlife Healthcare Staffing – Empowering Healthcare Professionals, Enriching Lives.

Job DescriptionAffirmative Civil Enforcement (ACE) InvestigatorEmployment Type: Full-Time, Experienced Department: Legal Services CGS is seeking an experienced ACE Investigator with extensive knowledge and skills in investigative techniques and fraud detection to provide assistance for a large Federal agency initiative. CGS brings motivated, highly skilled, and creative people together to solve the government’s most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities. Skills and attributes for success:- The investigator will generate new investigations, and to continue with ongoing investigation and civil actions involving fraud in areas such as healthcare, contracting, and grants, as well as other fraud and abuse of federal public funds and programs.- Regularly meets with the ACE attorneys and with designated agency personnel for the purpose of generating fraud investigations.- Performs a variety of ancillary investigations-related services in direct support of any assigned fraud- Utilizes electronic databases such as public records, property records, business records, and other government-maintained databases, to identify documents, witnesses and other physical evidence.- Prepares reports on progress of investigations for use by AUSAs and supervisory attorneys. These reports may include significant findings and conclusions, analyses of information located in electronic databases, presentations, recommendations for additional investigative actions and candid assessments of strengths and weaknesses of witnesses, documentary evidence, or other aspects of a case.- Examines books, ledgers, payrolls, cost reports, billing statements, invoices, correspondence, computer data, and other records pertaining to the transactions, events, or allegations under investigation.- Performs sophisticated analyses of large-scale hard-copy and electronic data, such as health care claims data, financial transaction data, accounting records, or bank records to develop investigative leads and to determine their potential relevance to the allegations at issue.- Gathers and analyzes facts including witness statements, timelines, and scientific or technical data for the purpose of advancing investigative objectives. Establishes and verifies relationships between facts and evidence obtained or presented to confirm authenticity of documents, to corroborate witness statements, and to otherwise build proof necessary for successful litigation or settlement.- Develops and analyzes evidence and collects information relating to such evidence, or other legal matters under consideration, from appropriate primary and secondary sources. Performs analysis to clarify the target suspect's or organization's pattern of operations, to identify information relevant to the legal issues involved, and to recommend valuable approaches to the AUSAs or other members of the investigative team. Develops and refines proof required to assist in determining legal responsibility for violations.- Assists ACE AUSAs with in-person and/or telephonic interviews of witnesses, depositions, and sworn witness examinations.- Assists with the preparation and service of subpoenas for documentary materials, interrogatory answers, or witness testimony in connection with ACE investigations.- Develops an understanding of all applicable federal, state, or local laws to the extent necessary to make sound decisions on direction and scope of investigations. Determines proof required to affix responsibility for violations, and devise methods for obtaining, preserving, and presenting evidence to the greatest effect.- Assists with determining the most efficacious methods for planning, scheduling, and conducting investigations, and identifies any resources that may be required.- Performs other related ACE investigator duties as assigned and within scope.- Attends meetings and trainings as may be required and appropriate. Qualifications:- Computer Skills: Applicant shall have the ability to use MS Word, MS Excel, MS Outlook, MS Access, and other databases as well as Adobe Acrobat Professional. Experience with working on document review/management platforms such as Relativity, with analyzing spreadsheets of claims data, and with utilizing docketing software is a plus.- Ability to review and understand the import of a wide variety of documents, both legal and non-legal, including Motions and Briefs.- Ability to think independently and to develop investigative strategies in response to the needs of a specific case.- Communication skills are extremely important. Applicant shall work and interact professionally and effectively with all levels of staff.- Ability to meet established deadlines and work as a team player in a professional office.- Skill in meeting and dealing with people in a courteous and tactful manner. Our Commitment:Contact Government Services (CGS) strives to simplify and enhance government bureaucracy through the optimization of human, technical, and financial resources. We combine cutting-edge technology with world-class personnel to deliver customized solutions that fit our client’s specific needs. We are committed to solving the most challenging and dynamic problems. For the past seven years, we’ve been growing our government-contracting portfolio, and along the way, we’ve created valuable partnerships by demonstrating a commitment to honesty, professionalism, and quality work. Here at CGS we value honesty through hard work and self-awareness, professionalism in all we do, and to deliver the best quality to our consumers mending those relations for years to come. We care about our employees. Therefore, we offer a comprehensive benefits package.- Health, Dental, and Vision- Life Insurance- 401k- Flexible Spending Account (Health, Dependent Care, and Commuter)- Paid Time Off and Observance of State/Federal Holidays Contact Government Services, LLC is an Equal Opportunity Employer. Applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Join our team and become part of government innovation! Explore additional job opportunities with CGS on our Job Board:https://cgsfederal.com/join-our-team/For more information about CGS please visit: https://www.cgsfederal.com or contact:Email: info@cgsfederal.com #CJ We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

HELP USA is seeking an Administrative Assistant to support the Executive Director at one of our shelter locations.Your responsibilities will include:.Preparing reports, presentations, and correspondence as needed using Microsoft Office applications.Managing communications by email and telephone, con

Duration: 0-6 month(s) Additional Job Details: 4 days RTO (work in the office); 1 day WFH (work from home) Daily tasks related to administration and office management include, but are not limited to: travel and expense management, cost control implementation, acting as SPOC for visiting employees, T

The Lenfest Center for Sustainable Energy (LCSE) is seeking a motivated and detail-oriented student to assist with website management and faculty logistical communications.This role is ideal for a student interested in digital communication, and academic administration.Assist in updating and maintai

Administrative Assistant (P/T)-Higher Education.Our client, an esteemed institution in the higher education sector, is seeking a dedicated Administrative Assistant (P/T)-Higher Education to join their dynamic team.As an Administrative Assistant (P/T)-Higher Education, you will be an integral part of

The receptionist will interact with guests to provide information in response to inquiries about products and services and to handle and resolve complaints.Office duties: include but are not limited to; basic secretarial duties such as; answering/returning phone calls, emails regarding guest complai

PIMCO is a global leader in active fixed income with deep expertise across public and private markets.We invest our clients' capital across a range of fixed income and credit opportunities, leveraging our decades of experience navigating complex debt markets.Our flexible capital base and deep relati

Administrative Assistant/Entitlements Specialist.Location: Tinton - 880 Tinton Ave.Since 1967, Odyssey House has gone beyond helping individuals beat drugs and alcohol.There's more to recovery than just getting clean.We help individuals get healthy again, too, with medical and dental care, fitness p

Take detailed clinical phone messages for physician or advanced allied healthcare provider. When you join us, you become part of Mount Sinai's unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. National Institutes of Health funding and in the 9

The executive assistant role will be responsible for assisting with the management and coordination of the administrative functions in support of the energy infrastructure credit business.Participates in ongoing production processing and performs basic operational tasks under direct supervision.Key

BizTek People is seeking an experienced Administrative Assistant with a background in Investment Banking for a client located in New York, NY! Administrative Assistant Investment & Corporate Banking Work Schedule: In-office, Monday through Friday, 8:30 a.Overview: A detail-oriented Administrative As

Take detailed clinical phone messages for physician or advanced allied healthcare provider. When you join us, you become part of Mount Sinai's unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. National Institutes of Health funding and in the 9

NYC Department of Finance (DOF) is responsible for administering the tax revenue laws of the city fairly, efficiently, and transparently to instill public confidence and encourage compliance while providing exceptional customer service.DOF's Customer Operations Division has oversight of the Departme

Abraham Joshua Heschel School is seeking an administrative assistant to support the Lower School Judaic Studies team.The Judaic Studies (JS) Assistant provides administrative, logistical, and Hebrew-language curricular support for the department.Key responsibilities include managing departmental ope

The ideal candidate is organized, professional, detail-oriented, and able to work effectively in a fast-paced healthcare environment. Prior administrative or healthcare office experience preferred.

Administrative Assistant Equity Research.Jefferies Group LLC, the largest independent, global, full-service investment banking and capital markets firm headquartered in the U.We offer deep sector expertise across a full range of products and services in investment banking, equities, fixed income, a

Senior Administrative Assistant.Department: Office of the President.Education Level: BA/BS or combination of education and experience.Church Pension Group (CPG) is a financial services organization that serves the Episcopal Church, located in Midtown Manhattan.CPG was founded in 1917 to provide pens

Volunteers of AmericaGreater New York (VOAGreater New York) is a leading anti-poverty organization serving neighbors in need across New York City, Northern New Jersey, and Westchester.Through 70+ programs, we support over 35,000 adults and children each year, including individuals experiencing homel

Legal Administrative Assistant.This position requires a motivated self-starter with the ability to change directions and handle multiple tasks on a regular basis.Must be professional, dedicated and possess excellent administrative skills.Must have at least 1 year experience in a legal administrative

What is the opportunity? Administrative Assistant position supporting Equity Research.Prepare expense reports using web-based reporting system.Update and maintain client contacts in database.Creation, editing and formatting of PowerPoint presentations, correspondence and reports for internal and ext

USTA National Tennis Center Administrative Support.We are Tennis! The USTA (United States Tennis Association) is the national governing body for the sport of tennis and the leader in promoting and developing the sport's growth on every level in the United States, from local communities to the crown

Non-profit staff can work anywhere.A nationally recognized comprehensive Health and Human Services Agency, with over 60 programs across New York City and the greater New York Area.Samaritan Daytop Village serves over 33,000 New Yorkers annually within your neighborhoods and communities, so our succe

Location: Midtown Manhattan, NY.Industry: Corporate Consulting.As an Administrative Assistant, you will play a crucial role in supporting the efficient functioning of the office.This is a fast-paced environment, and your ability to multitask, manage calendars effectively, and maintain a keen attenti

Our client, a dynamic investment firm, is looking for an Administrative Assistant to provide executive support to members of their team.The candidate will collaborate closely with other administrative staff, supporting team initiatives and ensuring seamless day-to-day operations.This is an amazing o

SLR International Corporation is currently seeking a full-time administrative professional with a high level of attention to detail to work in a fast-paced professional office environment.The administrative professional should be highly skilled in front desk services, management of inventory and com

The New York County District Attorney's Office (DANY) has an opening for an Administrative Assistant in its Survivor Services Bureau (SSB).In this position the Administrative Assistant will provide support to (SSB).The Administrative Assistant reports directly to the Bureau and Deputy Chiefs and is

Performs diversified clerical duties related to the operational needs of the office/department.Performs diversified clerical duties which may include, but are not limited to: Typing various correspondence, reports, articles; Greeting and directing visitors; Answering telephones, taking messages, dir

Administrative Assistant/h2pCAMBA is a community of staff, volunteers, clients, donors, neighbors and partners who work together to build an inclusive New York City, where all children and adults have access to the resources and supports they need to thrive.We take a comprehensive approach by offeri

Administrative Assistant (INJ).Salary/year Position Type Full Time.Intro/Program Description: This position is a part of the Innovation and Justice Division (INJ).This division is responsible for forward-looking developments that build our institutional capacity and improve our impact by fostering l

Program Department Administrative Assistant.New York Edge seeks a dynamic, motivated and highly organized individual to fill the role of Program Department Administrative Assistant.In this part-time role, you will be responsible for providing administrative support in the management of the daily ope

When you join us, you become part of Mount Sinai's unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American

Administrative Assistant II (Bedford-Stuyvesant YMCA).The YMCA of Greater New York is here for all New Yorkers to empower youth, improve health, and strengthen community.Founded in 1852, today the Y serves a diverse population of more than half a million New Yorkers who learn, grow, and thrive thro

Executive Assistant Opportunity.Raphael & Associates is a globally recognized third-party claims administrator and independent claims adjusting firm, known for delivering exceptional service.We understand the importance of staying agile in a dynamic market and pride ourselves on tailoring our soluti

Administrative Assistant (BWC TEP).Bernie Wohl - New York, NY 10024.Goddard Riverside is working in collaboration with the New York City Department of Youth and Community Development to alleviate the effects of poverty and provide opportunities by operating a Beacon Community Center on the Upper Wes

Senior Administrative Assistant.Become an integral part of Consumer & Community Banking team where you will have the opportunity to work in a fast-paced organization and each day will be unique! This role provides a platform for professional growth and skill enhancement.Be part of a team that is res

We are seeking a passionate and dedicated Administrative Assistant to join our team.At The Learning Experience, you'll have the opportunity to create a positive and engaging environment for children, where "happy happens here" is more than just a mottoit's a way of life.We're looking for someone com

Administrative Assistants Needed/h2pAdministrative assistants needed for a medical screening project in Bronx NY!/ppMedical experience is not required - we offer paid training.Schedule: Monday-Friday, 9am-5pm/ppRole: Use Microsoft Teams and Microsoft Excel for data entry, manage communication betwee

At BNY, our culture empowers you to grow and succeed.As a leading global financial services company at the center of the world's financial system we touch nearly 20% of the world's investible assets.Every day around the globe, our 50,000+ employees bring the power of their perspective to the table t