Manager, Special Investigative Unit – Program Integrity – CPC

This is a fully remote position, open to applicants in Alabama, +25 more states.

📋 Description

• Oversee a team of Special Investigative Unit (SIU) Investigators spanning multiple states.

• Communicate findings to the relevant government and regulatory bodies.

• Engage in extensive interactions with internal departments, providers, and government organizations.

• Assess and suggest revisions to health plan regulations and policies concerning fraud, waste, and abuse.

• Offer compliance guidance and assist with organizational changes and interpretations related to fraud, waste, and abuse.

• Facilitate the monthly Fraud, Waste, and Abuse (FWA) subcommittee meetings.

⛳️ Requirements

• Bachelor’s degree is REQUIRED.

• Certified Professional Coder (CPC) is REQUIRED.

• A minimum of 2 years of supervisory experience is REQUIRED.

• Experience in the insurance field is REQUIRED.

• At least 5 years of coding experience is REQUIRED.

• Previous leadership experience managing a pre-pay review team is preferred.

• Familiarity with overseeing pre-payment claim reviews, provider monitoring activities, medical record audits, and payment integrity operations within a healthcare payer setting.

• Availability to work from 8am to 5pm EST, Monday through Friday.

• Willingness to work multiple shifts as needed.

🏝️ Benefits

• Medical, Dental, and Vision insurance plans.

• Adoption, Fertility, and Surrogacy Reimbursement up to $10,000.

• Paid Time Off and Sick Leave.

• Paid Parental and Family Caregiver Leave.

• Emergency Backup Care services.

• Long-Term and Short-Term Disability, along with Critical Illness plans.

• Life Insurance coverage.

• 401k/403B plan with Employer Match.

• Tuition Assistance of $5,250 per year and discounted educational opportunities through Guild Education.

• Student Debt Pay Down benefit of $10,000.

• Pet Insurance options.

• Access to Legal Resources Plan.

• Annual discretionary bonus opportunity based on established criteria and employee eligibility.

• Family-friendly workplace culture.

• Opportunities for professional development and career growth.

• Annual travel to Virginia Beach.