Clinical Fraud Investigator II
Locations: 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. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
PLEASE NOTE: This position is not eligible for current or future VISA sponsorship.
The Clinical Fraud Investigator II is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse.
How you will make an impact:
Minimum Requirements:
Requires an Associate Degree in Nursing and/or current certification as a Certified Professional Coder (AAPC or AHIMA) and minimum of 4 years related experience, including minimum of 1 year experience in a Clinical Fraud and Abuse Investigation area; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Experiences and Competencies:
Job Level: Non-Management Exempt
Workshift: 1st Shift (United States of America)
Job Family: FRD > Investigation
Clinical Fraud Investigator II • Cincinnati, OH, United States
We are seeking a QMS Consultant to support and maintain Quality Management System (QMS) processes for medical device projects in compliance with regulatory requirements.The ideal candidate will col... Show more
Employment Opportunity Butler County Educational Service Center August 6, 2026.WORK YEAR: Part-time, 130 Days.GENERAL DESCRIPTION: To ensure, via coordination, management and facilitation, the iden... Show more
JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes.Responsible for verifying that services are medically necessary and align with established clini... Show more
The position is based in Springdale, Ohio and requires a minimum of two days a week in office.Be part of an amazing story Macy's is more than just a store.One that's captured the hearts and minds o... Show more
Senior Residential Title ExaminerThe National Operations team at Anywhere Integrated Services is currently seeking a Senior Residential Title Examiner to join our Title Production team.This is a re... Show more
Normal hours of operation M-F 6a-2:30p and rotating Saturdays 6a-10a.Must have OH LCDCIII, LICDC, LISW, or LPCC.Responsible for the Hamilton and Springfield, OH outpatient offices.We offer competit... Show more
Internal Audit Auditor II - OperationsBe part of an amazing storyMacy's is more than just a store.One that's captured the hearts and minds of America for more than 160 years.A story about innovatio... Show more
Chief - Division of Clinical Pathology University of Cincinnati Position Highlights :Reasonable and balanced distribution of Responsibilities:65% administrative, 30% clinical, 5% teaching Collabora... Show more
Confident Staff Solutions is a leading staffing agency in the healthcare industry, specializing in providing top talent to healthcare organizations across the country.Our team is dedicated to helpi... Show more
Develop integrated baseline project plans applying estimating models, identify resources and skills required, document estimating assumptions, refine plans and manage performance against them.Recom... Show more
Verifies merchandise and cash in each of the Company stores by conducting a physical count using a hand held computer.Notifies store manager of wrong prices and pulls out-of-code merchandise.Count ... Show more
Americas Delivery Center - Financial Crimes Compliance AnalystProtiviti's Americas Delivery Center is seeking an Analyst to join our financial crimes compliance competency.Embracing Protiviti's vis... Show more
We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively.Since launching in 1996, IRI has attracted, assembled and retained key employ... Show more
Join the Hidden Roots Family Clinician (OHIO).At Hidden Roots Mental Health, LLC, we're more than a mental health provider we're a movement rooted in compassion, connection, and care.Our mission is... Show more
Kettering Health Inpatient Hospital Pharmacy Technician.Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio.We are commi... Show more
Business Analyst - Compliance/Fraud.SAS Rate: $ DOE on W2 Location: Cincinnati, OH.Risk and fraud application experience.Business knowledge: Financial Crime Risk / Fraud/ Compliance / Regulatory pr... Show more
Daytime Rounding Hospitalist position just came available, be the first to apply before gone, this position will go quickly! Open to full or partime employment.This Indiana Hospitalist position is ... Show more
Mortgage InspectorNOFS (Northern Ohio Field Services) is currently seeking an experienced Mortgage Inspector to join our growing team in Butler County Ohio.As a Mortgage Inspector at NOFS, you will... Show more
Medpace is the leading CRO for Biotech companies and is continuing to add established Clinical Trial Managers and Project Managers with a focus on Infectious Diseases to join our Clinical Trial Man... Show more
Business Analyst - Compliance/Fraud.SAS Rate: DOE on W2 Location: Cincinnati, OH.Risk and fraud application experience.Business knowledge: Financial Crime Risk / Fraud/ Compliance / Regulatory proj... Show more
