Career Services

By John Stabinger
Posted on 2 April 2020 | 2:40 pm

Alumni Career Services

Job Seekers, Welcome to ALUMNI CAREER CENTER
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College of Charleston

Charleston, South Carolina

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Medical University of South Carolina

Charleston, South Carolina

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American Academy of Otolaryngology-HNSF

Alexandria, Virginia

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First Federal Savings of San Rafael

San Rafael, California

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Novartis

East Hanover, New Jersey

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Geisinger

Bloomsburg, Pennsylvania

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Banner Health

Scottsdale, Arizona

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Banner Health

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Emanuel Medical Center

Turlock, California

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Albuquerque, New Mexico

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University of Washington

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Geisinger

Danville, Pennsylvania

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Danville, Pennsylvania

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San Francisco, California

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Clinical Auditor Fraud Waste and Abuse
Job SummaryResponsible for the management of clinical reviews to assist in the prevention and detection of fraud, waste and abuse in all the Health Plan lines of business. Plan, organize, and execute medical reviews or audits that identify, evaluate and measure potential healthcare fraud and abuse.Job DutiesUtilizes an expert knowledge of CPT, ICD-9, HCPCS coding and the Health Plan clinical and reimbursement policies to review and analyze claims and corresponding medical records for clinical medical record reviews.Prepares concise clinical review summaries to support findings of potential fraud, waste and abuse Conducts in-depth research and makes recommendations to clarify coding and billing issues identified in fraud, waste and abuse cases.


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