Remote SIU Manager: Healthcare Fraud & Compliance

Sentara Health; Virginia; Hybrid; USD 109,000 - 163,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k/403B with Employer Match

Paid Time Off and Holidays

Educational assistance or student loan

Job summary

Sentara Health Plans seeks a senior leader to manage a multi-state SIU team and report findings to appropriate government agencies. The role requires extensive collaboration with internal departments, providers, and regulatory bodies to refine health plan fraud, waste, and abuse policies while guiding organizational change and compliance interpretation.

With a base focus on Virginia health plans, the position includes remote opportunities across numerous states, occasional travel to Virginia

Qualifications

• Bachelor’s degree required.
• CPC certification required.
• 2 years of supervisory experience.
• 5 years of coding experience.
• Insurance experience preferred.

Responsibilities

• Manage a team of SIU Investigators across multiple states.
• Report findings to government and regulatory agencies.
• Interact with internal departments, providers and government agencies.
• Review and propose updates to health plan rules related to fraud, waste and abuse.
• Provide compliance advice and assist with organizational change and interpretation of compliance.

Skills

Supervisory experience

Insurance experience

Coding experience

Education

Bachelor’s degree

CPC certification

Job description

Sentara Health Plans seeks a senior leader to manage a multi-state SIU team and report findings to appropriate government agencies. The role requires extensive collaboration with internal departments, providers, and regulatory bodies to refine health plan fraud, waste, and abuse policies while guiding organizational change and compliance interpretation.

With a base focus on Virginia health plans, the position includes remote opportunities across numerous states, occasional travel to Virginia