Remote SIU & Program Integrity Manager (CPC)

Sentara Health; Richmond (VA); Remote; USD 109,000 - 163,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401(k) match

Paid Time Off

Job summary

Sentara Health Plan is seeking a Manager, Special Investigative Unit/Program Integrity to lead a nationwide SIU team. This remote role supports fraud, waste, and abuse investigations and requires collaboration with internal teams and external agencies.

Applicants should have CPC certification, a Bachelor’s degree, and at least 2 years of supervisory experience in a healthcare payer setting, with 5 years of coding and prior pre-pay review leadership.

Qualifications

• Bachelor’s degree is required for this role.
• CPC certification is required.
• Minimum 2 years of supervisory experience.
• Insurance industry experience required.
• Minimum 5 years of coding experience and leadership in pre-pay review.

Responsibilities

• Manage SIU investigators across multiple states.
• Report findings to government and regulatory agencies.
• Review and update health plan rules related to FWA.
• Provide compliance guidance and interpret changes for the team.
• Lead the monthly FWA subcommittee meeting.

Skills

Supervisory experience

Healthcare payer experience

Regulatory and compliance knowledge

Leadership and team management

Education

Bachelor’s degree

Certified Professional Coder (CPC)

Job description

Sentara Health Plan is seeking a Manager, Special Investigative Unit/Program Integrity to lead a nationwide SIU team. This remote role supports fraud, waste, and abuse investigations and requires collaboration with internal teams and external agencies.

Applicants should have CPC certification, a Bachelor’s degree, and at least 2 years of supervisory experience in a healthcare payer setting, with 5 years of coding and prior pre-pay review leadership.