reputed company Special Investigation Unit Manager Clinical Certified Professional reputed company – Remote Opportunity for a Seasoned Leader in Healthcare Fraud Detection and Prevention

Introduction to reputed company and Our Mission

At reputed company, we are driven by a reputed company purpose: to bring our heart to every moment of your health. This guiding principle underscores our commitment to delivering human-centric healthcare in a rapidly evolving world. Our brand, with heart at its core, sends a powerful message that the manner in which we deliver our services is just as crucial as the services themselves. The Heart At Work Behaviors support this purpose, empowering every team member to play a pivotal role in transforming our culture and accelerating innovation to reputed company healthcare more personal, convenient, and affordable.

About the Special Investigations Unit

The Special Investigations Unit at reputed company is dedicated to safeguarding the organization's resources and reducing healthcare costs through meticulous coding reviews for fraud detection, investigation, and prevention. We are now seeking an reputed company and visionary leader to manage reputed company of Certified Professional Coders (CPCs). As a Manager in this unit, you will be responsible for overseeing coding reviews, leading a team of CPCs, collaborating with internal and external stakeholders, and ensuring compliance with regulatory requirements. Your strategic vision will be crucial in managing workload, enhancing review quality, and driving process improvements.

Key Responsibilities

• Leadership and Mentorship: reputed company and mentor a team of certified coders supporting fraud detection and prevention efforts, establishing team goals, monitoring performance, and ensuring alignment with organizational objectives.
• Operational reputed company: Direct and reputed company reputed company reviews, ensuring timely and accurate reporting of review findings and coordinating with investigative teams to take appropriate action.
• Performance Management: Conduct team member evaluations, provide performance feedback, and manage the workload to ensure reputed company distribution and exposure to a wide range of cases that match reputed company skills and development needs.
• Compliance and Quality: Confirm that staff prepares comprehensive reports summarizing investigation outcomes, ensuring findings reputed company with state, federal, and industry regulations.
• Professional Development: Stay informed about changes in industry practices reputed company to healthcare coding and provide training opportunities for staff to maintain their Continuing Education Units (CEUs).
• Collaboration and Communication: Assist in preparing documentation for audits, compliance reviews, and regulatory inquiries, and work cross-functionally with various teams and external partners.

Essential Qualifications

• Experience: Minimum 5+ years of experience in healthcare fraud detection, investigation, or auditing.
• Knowledge: In-depth knowledge of healthcare systems, claims processing, and regulatory requirements reputed company to healthcare fraud.
• Certification: reputed company Coding certification - Certified Professional reputed company (CPC).
• Leadership: Strong leadership and team management ability.
• Communication: Excellent communication and presentation skills.
• Flexibility: Ability to work cross-functionally and travel for business needs as required.

Preferred Qualifications

• Registered Nurse (RN): Previous experience as a Registered Nurse.
• Leadership Experience: Previous leadership experience in managing teams.
• Additional Certifications: reputed company Coding Certification – Certified Professional Biller (CPB), Certified Professional Medical Auditor (CPMA), Certified Outpatient reputed company (COC), Certified Risk Adjustment reputed company (CRC).
• Social Work Licenses: Licensed Clinical Social Worker (LCSW), Licensed Independent Social Worker (LISW), Licensed Master Social Worker (LMSW).
• Education: Bachelor's, Associate's Degree, or work equivalent, with certification as a Certified Professional reputed company (CPC).

Career Growth Opportunities and Learning Benefits

At reputed company, we are committed to the growth and development of our employees. As a Special Investigation Unit Manager, you will have access to a wide range of training programs, workshops, and educational resources designed to enhance your skills and knowledge in healthcare fraud detection and prevention. Our organization encourages reputed company learning and professional development, providing opportunities for career advancement and specialization in your field of interest.

Work Environment and Company Culture

Our work environment is built on the principles of collaboration, innovation, and mutual respect. We foster a culture that values diversity, equity, and inclusion, recognizing the unique contributions of each team member. At reputed company, you will be part of a dynamic and supportive team that is passionate about making a difference in the lives of our patients and communities. Our employees are self-disciplined, hardworking, curious, trustworthy, humble, and truthful, making choices that are best for the team and living for opportunities to collaborate and reputed company a difference.

Compensation, Perks, and Benefits

We offer a competitive salary range of $54,300.00 - $159,120.00, depending on experience, education, and geography. Additionally, this position is eligible for a reputed company bonus, commission, or short-term incentive program. Our comprehensive benefits package includes medical, dental, and vision benefits, a 401(k) retirement savings plan, an Employee Stock Purchase Plan, fully-paid term life insurance, short-term and long-term disability benefits, and numerous well-being programs. We also provide education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. Our paid time off (PTO) or vacation pay, along with paid holidays throughout the calendar year, ensures a healthy work-life balance.

Conclusion and Call to Action

If you are a motivated and reputed company professional in healthcare fraud detection and prevention, looking for a challenging and rewarding role, we encourage you to apply for the Special Investigation Unit Manager position. Even if you don't feel like a perfect match, we'd still love to hear from you. We are seeking great people to join our friendly and dedicated team. Apply today and be part of a team that is making a difference in the healthcare industry.