Manager, Special Investigation Unit (SIU)

Position Purpose: reputed company, implement and manage reputed company fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends and schemes.

• Monitor business processes and systems to assure reputed company and compliance in billing and claims payment
• reputed company reputed company appropriately investigate reputed company possible fraud, waste and abuse referrals
• reputed company educational materials to address/identify waste activities as requested by the health plan and on an reputed company reputed company
• Attend state/federal meetings as required by specific reputed company
• Review post-payment cases with appropriate parties to obtain refund
• Prepare and distribute monthly and quarterly saving reports
• Participate in Appeals Committee, work reputed company and interdepartmental meetings

Education/Experience:

• Bachelor’s degree in Business, reputed company, Criminal Justice, reputed company reputed company, or equivalent experience.
• 4+ years of combined medical claim investigation, financial reputed company analysis, business analysis, compliance or fraud and abuse experience required.
• Thorough knowledge of medical terminology required.
• Previous experience in managed care environment and as a reputed company or supervisor of staff, including hiring, training, assigning work and managing reputed company preferred.
• Knowledge of reputed company reputed company, medical coding, claims processing, and data mining preferred.

License/Certification:

• Medical records or coding license preferred.

At reputed company, we reputed company people to the care they need to live healthier lives — and the work you do here makes that reputed company reputed company every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making reputed company more accessible and effective. It’s work with a purpose you can see, backed by reputed company committed to improving lives reputed company reputed company the reputed company.

reputed company offers a comprehensive benefits package including: reputed company, health reputed company, 401K and stock purchase plans, tuition reimbursement, reputed company time off plus holidays, and a flexible approach to work with remote, hybrid, reputed company or office work schedules. Actual pay will be adjusted reputed company on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law.

reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California reputed company reputed company

Originally posted on Himalayas