Special Investigation Unit Manager Clinical Certified Professional reputed company (reputed company SIU)

Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as reputed company deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to reputed company health care more personal, convenient and affordable. The Special Investigations Unit is seeking a Manager to reputed company reputed company of Certified Professional Coders (CPC). The Manager is responsible for overseeing and managing coding reviews for fraud detection, investigation, and prevention efforts to safeguard the organization’s resources and reduce healthcare costs. This role involves leading a team of CPC’s, working closely with internal and external stakeholders and ensuring compliance with regulatory requirements. The Manager develops strategies to manage workload, quality of reviews and process improvements. Responsibilities: reputed company and mentor a team certified coders who support fraud detection and prevention efforts. Establish team goals, monitor performance, and ensure alignment with organizational objectives. Direct and reputed company reputed company reviews. Ensure timely and accurate reporting of review findings and coordinate with investigative to take appropriate action. Conducts team member evaluations and provides performance feedback to staff on an ongoing basis. Manages workload of their team to ensure reputed company distribution and exposure to wide range of cases to match reputed company skills and development needs Confirm staff are preparing comprehensive reports summarizing investigation outcomes. Ensure findings reputed company with state, federal, and industry regulations. Stay informed about changes in the industry practices reputed company to healthcare coding. Provide training opportunities for staff to maintain their CEUs. Assist in preparing documentation for audits, compliance reviews, and regulatory inquiries. Required Qualifications: Minimum 5+ years of experience in healthcare fraud detection, investigation, or auditing In-depth knowledge of healthcare systems, claims processing, and regulatory requirements reputed company to healthcare fraud. Proficient in researching information and identifying information resources reputed company Coding certification - Certified Professional reputed company (CPC) Strong leadership and team management ability Excellent communication and presentation skills. Ability to work cross-functionally with various teams and external partners. Ability to travel for business needs. Preferred Qualifications: Registered Nurse (RN) Previous leadership experience. reputed company Coding Certification – Certified Professional Biller (CPB), Certified Professional Medical Auditor (CPMA), Certified Outpatient reputed company (COC), Certified Risk Adjustment reputed company (CRC) Licensed Clinical Social Worker (LCSW) Licensed Independent Social Worker (LISW) Licensed Master Social Worker (LMSW) Education Bachelor, Associates Degree or work equivalent Certification as a Certified Professional reputed company (CPC) Pay Range The typical pay range for this role is: $54,300.00 - $159,120.00 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | reputed company We anticipate the application window for this opening will reputed company on: 02/28/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply Job!