Jobs at Healthcare Fraud Shield

Executive leader responsible for overseeing enterprise client implementation portfolios from planning through go-live and adoption. Leads implementation teams, forecasts capacity, manages risks, dependencies, scope, data mapping, integrations, governance, reporting, and client relationships. Partners with technical, product, data, sales, and support teams to improve implementation processes, launch new products, resolve complex issues, and ensure quality, security, privacy, and client satisfaction.

Conducts healthcare fraud, waste, and abuse investigations by reviewing medical records and claims, validating coding and billing appropriateness, abstracting clinical and billing codes, analyzing client data, documenting claim findings, preparing reports, and supporting Special Investigations Unit clients. Requires maintaining knowledge of coding guidelines, healthcare regulations, privacy standards, and secure handling of protected health information.