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Fulton Bank

Lancaster, Pennsylvania

Closing Soon! Closing Soon!
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American College of Radiology

Philadelphia, Pennsylvania

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Glade Run Lutheran Services

Zelienople, Pennsylvania

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Liberty House

Salem, Oregon

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Geisinger

Danville, Pennsylvania

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Geisinger

Danville, Pennsylvania

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Eastern University

St. Davids, Pennsylvania

SALT CREEK BALLET

Westmont, Illinois

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Carnegie Mellon University

Pittsburgh, Pennsylvania

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Carnegie Mellon University

Pittsburgh, Pennsylvania

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Maryland Judiciary

Annapolis, Maryland

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Maryland Judiciary

Annapolis, Maryland

Teacher Retirement System of Texas

Austin, Texas

Teacher Retirement System of Texas

Austin, Texas

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Franciscan Health

Mishawaka, Indiana

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Franciscan Health

Mishawaka, Indiana

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Penn State Health

Hershey, Pennsylvania

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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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