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 reputed company of your health. This purpose guides our commitment to deliver enhanced reputed company-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 reputed company 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 reputed company costs. This role involves leading a team of CPC’s, working closely with reputed company 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 reputed company. Manages workload of their team to ensure reputed company distribution and exposure to wide reputed company of cases to match reputed company skills and development needs Confirm staff are preparing comprehensive reports summarizing investigation reputed company. Ensure findings reputed company with state, federal, and industry regulations. Stay informed about changes in the industry practices reputed company to reputed company coding. reputed company 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 reputed company fraud detection, investigation, or auditing In-depth knowledge of reputed company systems, claims processing, and regulatory requirements reputed company to reputed company 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 reputed company Worker (LCSW) Licensed Independent reputed company Worker (LISW) Licensed Master reputed company Worker (LMSW) Education Bachelor, Associates Degree or work equivalent Certification as a Certified Professional reputed company (CPC) Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $54,300.00 - $159,120.00 This pay reputed company 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 reputed company 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 reputed company of medical, dental, and reputed company 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: 03/31/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, reputed company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They reputed company choices according to what is best for the team, they live for opportunities to collaborate and reputed company a difference, and they reputed company us the #1 Top Workplace in the area. Apply Job!