Special Investigation Unit Manager Clinical Certified Professional Coder – Aetna SIU
| Company | CVS Health |
|---|---|
| Location | New Mexico, USA, Washington, USA, Kansas, USA, Pennsylvania, USA, North Dakota, USA, Oregon, USA, Iowa, USA, Washington, DC, USA, Vermont, USA, Wyoming, USA, Texas, USA, Montana, USA, Jackson Township, NJ, USA, TX, USA, Nevada, USA, South Carolina, USA, South Dakota, USA, Georgia, USA, Arizona, USA, Concord, NH, USA, Mississippi, USA, Tennessee, USA, Arkansas, USA, Minnesota, USA, Nebraska, USA, Rhode Island, USA, Utah, USA, Oklahoma City, OK, USA, Kentucky, USA, West Virginia, USA, New York, NY, USA, Maryland, USA, Wisconsin, USA, Maine, USA, Massachusetts, USA, North Carolina, USA, Missouri, USA, Ohio, USA, Indiana, USA, Louisiana, USA, Michigan, USA, Alabama, USA, Idaho, USA |
| Salary | $54300 – $159120 |
| Type | Full-Time |
| Degrees | |
| Experience Level | Senior |
Requirements
- Minimum 5+ years of experience in healthcare fraud detection, investigation, or auditing
- In-depth knowledge of healthcare systems, claims processing, and regulatory requirements related to healthcare fraud.
- Proficient in researching information and identifying information resources
- AAPC Coding certification – Certified Professional Coder (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.
Responsibilities
- Lead 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 oversee complex 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 equitable distribution and exposure to wide range of cases to match current skills and development needs
- Confirm staff are preparing comprehensive reports summarizing investigation outcomes.
- Ensure findings comply with state, federal, and industry regulations.
- Stay informed about changes in the industry practices related to healthcare coding.
- Provide training opportunities for staff to maintain their CEUs.
- Assist in preparing documentation for audits, compliance reviews, and regulatory inquiries.
Preferred Qualifications
- Registered Nurse (RN)
- Previous leadership experience.
- AAPC Coding Certification – Certified Professional Biller (CPB), Certified Professional Medical Auditor (CPMA), Certified Outpatient Coder (COC), Certified Risk Adjustment Coder (CRC)
- Licensed Clinical Social Worker (LCSW)
- Licensed Independent Social Worker (LISW)
- Licensed Master Social Worker (LMSW)