Special Investigation Unit Manager Clinical Certified Professional reputed company (reputed company SIU)

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. 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 internal and external 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. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 05/25/2025 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, our 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!