Manager, Special Investigative Unit/ Program Integrity/ CPC - Remote

United StatesRemotemid

Other

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Quick Summary

Key Responsibilities

Position is responsible for managing a team of Special Investigative Unit (SIU) Investigators across multiple states.

Requirements Summary

If an annual salary is posted, it is based on a full-time colleague working 2,080 hours annually.

Sentara offers a comprehensive benefits package, including medical, dental, vision,

Technical Tools

Other

City/State

Norfolk, VA

Work Shift

Multiple shifts available

Responsibilities

~1 min read

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Position is responsible for managing a team of Special Investigative Unit (SIU) Investigators across multiple states.
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Is also responsible for reporting findings to appropriate government and regulatory agencies.
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Position requires extensive interaction with various internal departments as well as providers and government agencies.
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Responsible for reviewing and proposing updates to health plan rules and policies as they relate to fraud, waste and abuse.
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Provides compliance advice and assists with organizational change and compliance interpretation as it relates to fraud, waste and abuse.
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Leads the monthly FWA subcommittee meeting.

Bachelor’s degree REQUIRED

Certified Professional Coder (CPC) REQUIRED

2 years of Supervisory experience REQUIRED
Insurance experience REQUIRED
5 years of Coding experience REQUIRED
Candidates must have prior leadership experience managing a pre-pay review team, including oversight of pre-payment claim reviews, provider monitoring activities, medical record reviews, and payment integrity operations within a healthcare payer environment.

What We Offer

~1 min read

#LI-PM1

Talroo-Health Plan

Keywords: Healthcare, Health Plan, Remote, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming, Bachelor's Degree, Medical Coding, Medical Chart Review, Insurance Billing, Internal/External Audit, Regulatory, Compliance, Claims Investigations, Criminal Investigation, White Collar Crime, Certified Professional Coder (CPC), Fraud, Waste, Abuse, Program Integrity, FWA, PI, SIU, Special Investigations Unit, Manager

We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay range for full-time employment is $109,033.60 - $163,259.20 annually. Additional compensation may be available for this role, such as shift differentials, on-call pay, shift premiums, extra-shift incentives, or bonus opportunities. Compensation within the range may vary based on qualifications, experience, location, market conditions, and business needs. Note: If an annual salary is posted, it is based on a full-time colleague working 2,080 hours annually. Sentara offers a comprehensive benefits package, including medical, dental, vision, life and disability insurance; 401(k)/403(b) with employer match; paid time off (vacation, sick time, and holidays); paid parental and military leave; educational assistance or student loan repayment; and voluntary benefits.

Nice to Have

~1 min read

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

Location & Eligibility

Where is the job

United States

Remote within one country

Who can apply

About this job

Pay per year: $109,034–$163,259 a year; 100% above the $68,210 median for Other jobs on Jobera (133,430 salaries).
Who can apply: United States
Posted: 27 days ago
Employer: has 2,267 open jobs on Jobera.