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Under general supervision, the Special Investigations Unit Medical Reviewer (SIU Medical Reviewer) performs reviews of medical records and healthcare claims to substantiate or refute the accuracy and compliance with federal and state regulations and contractual requirements of codes billed to identify coding errors and billing discrepancies in relation to incidents of suspected healthcare fraud, waste, and abuse (FWA) reported to IEHP’s Compliance Special Investigations Unit (SIU.
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Bachelor's degree in agronomy, animal science, biology, chemistry, or a related area from an accredited college or university AND Two years of experience conducting inspections and investigations for compliance or certification as a Registered Sanitarian or Environmental Health Specialist AND Two years of experience conduction inspection and investigation for compliance OR One year of experience required at the low-level Agriculture Compliance Specialist 2 (RCP041) or position equivalent.
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Categories: Healthcare/Medical Professional Level, Management/Supervisor, Healthcare/Nursing/Investigations/Compliance. Overseeing sample audits, reviewing provider records checking compliance with federal and state rules, regulations, and AHCCCS policies and procedures, and identifying recoupment amounts.
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The Senior Director of Financial Crimes Compliance, Financial Intelligence Unit is responsible for executing and maintaining elements of the financial crimes compliance risk management program for Freddie Mac, specifically the oversight of financial crimes related due diligence, investigations and SAR reporting framework.
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Proven experience in dealing with corporate compliance related issues, with strong knowledge of areas such as data privacy, international trade compliance, regulatory investigations, competition/anti-trust, anti-fraud/anti-bribery and anti-corruption.
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North Wind Site Services is focused on providing engineering, program management, environmental remediation services including investigation and characterization, environmental restoration, unexploded ordnance/military munitions response (MMRP), regulatory public involvement services, environmental compliance, logistics, and records and facility management.
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Provide comprehensive support for post-market surveillance activities, encompassing complaint investigations, Operations change control/risk assessments, document control, Quality Systems enhancements, Regulatory & certification audit preparedness, and internal audits.
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The position supports the overall BSA compliance efforts as required under the Bank Secrecy Act and the Bank's BSA/AML/ USA Patriot Act and OFAC Compliance Program and Procedures. This role has a working knowledge of BSA/AML/OFAC regulations and an overall understanding of banking products and services, preferably holds industry certifications, has experience working with anti-money laundering software, conducting investigations, and filing Suspicious Activity Reports (SARs.
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The FSO will be responsible for implementing and providing guidance to customers and management on security issues such as security education, insider threat, classified document control, security investigations, classification control and personnel clearances.
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Additionally, under requirements in CSU's Nondiscrimination Policy, 1111, 1115-1116, 1083, and 1107, serves as the Deputy Administrator for DHR, Title IX, ADA, Clery, Whistleblower/ Whistleblower Retaliation Investigations, and other compliance matters.
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In conjunction with Hospital Departments and Committees; e.g. Legal Office, the Hospital Safety Committee, Laboratory Medicine and Performance Management colleagues, works to assess the impact of quality projects on clinical operations as well as gauge readiness and compliance for internal and external surveys, and adverse event and complaint investigations by CMS, DPH/DOH, TJC, and others as needed.
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Plans and conducts various type of audits to include financial, operational, compliance, and IT audits along with investigations with the assistance of the Internal Audit Manager and Associate Director.
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Adequate educational background, plus an extensive (7+ years) experience in compliance, sanctions/AML/KYC investigations. To be successful in this role, you must have a demonstrated ability leading a global trade compliance function, with a special focus on economic sanctions and foreign trade laws.
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The PSA Compliance Manager will work with a multidisciplinary team experienced in the provision of programmatic services and in adherence to child welfare practices and external investigations.
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Works collaboratively with any department of UMMS and Member Organizations to research and resolve compliance investigations, including but not limited to, Member Organization Compliance Officers, Patient Financial Services, Reimbursement and Revenue Advisory Services, Health Information Management, Information Services and Technology, Case/Utilization Management, Quality, Pharmacy, Radiology, etc.
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