Special Investigations Unit Manager
VirtualVocationsHialeah, Florida, United Statesjob_description.job_card.1_day_ago
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- serp_jobs.job_card.full_time
job_description.job_card.job_description
A company is looking for a Special Investigations Unit (SIU) Program Manager.
Key Responsibilities
Develop, maintain, and execute the annual audit program
Manage the SIU referral intake and triage process, ensuring all referrals are investigated
Perform investigations into suspected fraud, waste, and abuse, including planning and reporting activities
Required Qualifications
Bachelor's degree or equivalent
Four (4) years of experience in managed care insurance focusing on payment integrity and special investigations
Knowledge of Medicare, Medicaid, and Commercial Coding rules and regulations
Experience in medical chart review / auditing
Preferred certifications include Certified Fraud Examiner (CFE) and Accredited Health Care Fraud Investigator (AHFI)
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Manager Special Unit • Hialeah, Florida, United States
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