Special Investigations Unit Manager

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)