Remote Manager, SIU & Program Integrity (CPC Certified)

Sentara Health Plans; Norfolk, Northern (VA, KY); Hybrid; USD 79,000 - 132,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k/403B with Employer Match

Paid Time Off

Tuition Assistance

Annual bonus opportunities

Job summary

Sentara Health Plans in Norfolk, VA, is seeking a Manager for the Special Investigative Unit/Program Integrity (CPC) role, supporting remote work across several states. You will lead a multi-state SIU team and coordinate with providers and government agencies.

The position requires a Bachelor's degree, CPC certification, and 5 years of coding experience with 2 years in supervision, plus strong alignment to fraud, waste and abuse controls.

Qualifications

• Bachelor’s degree REQUIRED
• 2 years of Supervisory experience REQUIRED
• 5 years of Coding experience REQUIRED
• Insurance experience REQUIRED
• CPC certification REQUIRED
• Experience leading pre-payment reviews and payment integrity in a healthcare payer environment REQUIRED

Responsibilities

• Manage a SIU team across multiple states and report findings to government/regulatory agencies.
• Interact with internal departments, providers and government agencies.
• Review/update health plan rules related to fraud, waste and abuse.
• Provide compliance advice and assist with organizational change and interpretation.
• Lead the monthly FWA subcommittee meeting.

Skills

Supervisory experience

Healthcare payer experience

Coding knowledge

Regulatory reporting

Education

Bachelor's degree

Job description

Sentara Health Plans in Norfolk, VA, is seeking a Manager for the Special Investigative Unit/Program Integrity (CPC) role, supporting remote work across several states. You will lead a multi-state SIU team and coordinate with providers and government agencies.

The position requires a Bachelor's degree, CPC certification, and 5 years of coding experience with 2 years in supervision, plus strong alignment to fraud, waste and abuse controls.