Remote SIU & Program Integrity Manager (CPC)

Sentara Health; Virginia (MN); On-site; USD 52,000 - 88,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k/403B with Employer Match

Paid Time Off

Job summary

Sentara Health Plan is hiring a Manager, Special Investigative Unit/ Program Integrity / CPC to lead a multi-state SIU team and oversee fraud, waste and abuse programs. Remote opportunity with annual travel to Virginia Beach.

Responsibilities include reporting findings to government agencies, collaborating with internal departments and providers, and updating health plan rules. Requires CPC, Bachelor's degree, and supervisory experience in healthcare coding.

Qualifications

• Bachelor’s degree REQUIRED.
• CPC Certification REQUIRED.
• 2 years of Supervisory experience REQUIRED.
• 5 years of Coding experience REQUIRED.
• Leadership experience managing SIU/pre-pay review teams in healthcare payer environments.

Responsibilities

• Lead a multi-state SIU Investigators team across states.
• Report findings to government and regulatory agencies.
• Interact with internal departments, providers and government agencies.
• Review and update health plan rules related to fraud, waste and abuse.
• Provide compliance guidance and drive organizational change.
• Lead the monthly FWA subcommittee meeting.

Skills

Leadership

Regulatory collaboration

Policy adherence

Healthcare coding

Education

Bachelor's degree

Tools

CPC (Certified Professional Coder)

Job description

Sentara Health Plan is hiring a Manager, Special Investigative Unit/ Program Integrity / CPC to lead a multi-state SIU team and oversee fraud, waste and abuse programs. Remote opportunity with annual travel to Virginia Beach.

Responsibilities include reporting findings to government agencies, collaborating with internal departments and providers, and updating health plan rules. Requires CPC, Bachelor's degree, and supervisory experience in healthcare coding.