- CVS Health (Bismarck, ND)
- …Professional Coder (CPC) Manager will oversee a team of medical coders within the Special Investigations Unit ( SIU ) to ensure compliance with coding ... medical, behavioral, transportation, and other healthcare providers. The CPC Manager will be responsible for guiding the team in...minimum of 2 years of managing staff within a Special Investigation Unit ( SIU ). +… more
- Elevance Health (Metairie, LA)
- Job Description **Investigator II - Payment Integrity SIU ** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration ... claims + Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company health plan, line… more
- AmeriHealth Caritas (Newtown Square, PA)
- …direct supervision of the Director, SIU the Pharmacy Manager in the Special Investigations Unit ( SIU ) will lead efforts to detect, investigate ... adherence to legal standards while minimizing risks to the organization. ; The manager must have the ability to determine correct coding, review claims, medical… more
- Humana (Juneau, AK)
- **Become a part of our caring community and help us put health first** The Special Investigations Unit Manager leads and monitors investigations of ... approach, resources, schedules and goals. **Where you Come In** The Special Investigations Unit Manager assists coordinating investigation with… more
- TD Bank (New York, NY)
- …TD Securities Compliance team is seeking a Surveillance Quality Assurance Manager to assist with building a global Surveillance Quality Assurance program. ... The Surveillance Quality Assurance Manager will help lead a specialized function responsible for...and will be part of the broader Surveillance Intelligence Unit , comprised of the Surveillance Data Quality Team, Surveillance… more
- Travelers Insurance Company (Lake Oswego, OR)
- …internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit . + ... Identifies and refers claims with Major Case Unit exposure to the manager . + Performs administrative functions such as expense accounts, time off reporting, etc.… more
- Travelers Insurance Company (Fort Worth, TX)
- …internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit . + ... Identifies and refers claims with Major Case Unit exposure to the manager . + Performs administrative functions such as expense accounts, time off reporting, etc.… more
- Highmark Health (Albany, NY)
- …and provides supporting documentation. *Identifies potential fraud cases and forwards to Special Investigations Unit . E3. Adjusts claims: *Performs online ... providers, internal and external customers; Adjusts claims. This is a bargaining unit position. The collective bargaining agreement for this position requires that… more
- CVS Health (Charleston, WV)
- …Health Care Anti-Fraud Association (AHFI) + Experience In Medicaid Compliance, Medicaid Investigations , MCO Medicaid FWA Unit in the following States: **Texas, ... Leads a team in the planning and execution of investigations of acts of healthcare fraud and abuse by...and development needs. Assesses training needs and works with SIU Director on development plans for team members. Develops… more
- Molina Healthcare (Covington, KY)
- …accountability for compliance by overseeing, follow-up and resolution of investigations . **KNOWLEDGE/SKILLS/ABILITIES** + Provides oversight and review of the ... SIU referral intake and investigation process while giving guidance and direction to team on case investigation steps and actions. + Works with leadership to maintain… more