Special Investigation Unit Manager

This is a fully remote position, open to applicants in Arizona, +3 more states.

📋 Description

• Supervise a team of medical coders in the Special Investigations Unit (SIU).

• Ensure adherence to coding practices through thorough reviews of records for medical, behavioral, transportation, and other healthcare providers.

• Provide guidance to the team in identifying correct coding and appropriate documentation during medical record assessments.

• Perform regular audits of team performance to guarantee compliance with CPT/HCPCS coding and documentation guidelines.

• Set team objectives, monitor performance, and ensure alignment with organizational goals.

• Oversee intricate coding reviews and address complex issues with sensitivity.

• Ensure team members generate comprehensive written summaries of their medical record review findings.

• Conduct evaluations of team members and offer constructive performance feedback.

• Collaborate with Medical Directors to confirm decisions and deliberate on complex cases.

• Manage the team's workload to ensure fair distribution and exposure to a diverse range of cases.

• Assist with investigative research related to coding queries and state and federal policies.

• Identify potential savings opportunities related to cases that may require a prepayment review.

• Maintain accurate records, files, and documentation for the team.

• Effectively utilize departmental resources and ensure adherence to workflows to meet performance metrics.

• Work in collaboration with investigators, data analytics, and plan leadership on SIU strategies and initiatives.

• Serve as the main point of contact for the team in the director's absence.

• Develop and implement training and onboarding programs for new team members.

⛳️ Requirements

• AAPC Coding certification is required.

• Minimum of 5 years of experience in medical coding or documentation auditing.

• Strong understanding of standard industry coding guides and guidelines, including CPT, HCPCS, ICD-10, CMS 1500, and UB04 data elements.

• Maintains current coding knowledge, including updates to coding compliance and reimbursement.

• Experience in researching coding and policy matters.

• A minimum of 3 years in a leadership position is required.

• Proficiency in Microsoft Office applications, particularly Excel and Word.

• Exceptional attention to detail and the ability to analyze and interpret data.

• Demonstrates strong communication and leadership abilities.

• Prior experience in auditing is preferred.

• Excellent analytical skills and the capacity to mentor and develop team members.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources based on eligibility.