Manager, Special Investigative Unit/ Program Integrity/ CPC - Remote
About The Position
Sentara Health Plan is currently hiring a Manager, Special Investigative Unit/ Program Integrity / CPC - Remote! This is a full-time, permanent position (40 hours) with work hours from 8am to 5pm EST, Monday to Friday. Remote opportunities are available in multiple states including Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming. The role requires travel to Virginia Beach once a year. Sentara Health Plans provides health plan coverage to close to one million members in Virginia, offering a full suite of commercial products, as well as plans serving Medicare and Medicaid enrollees. The company boasts a quality provider network and offers programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services. The company culture is described as family-friendly, encouraging community involvement and offering unlimited opportunities for development and growth. Sentara Health is an equal opportunity employer that values diversity, inclusion, and belonging, ensuring its workforce reflects the communities it serves. This is a tobacco-free environment.
Requirements
- Bachelor’s degree REQUIRED
- Certified Professional Coder (CPC) REQUIRED
- 2 years of Supervisory experience REQUIRED
- Insurance experience REQUIRED
- 5 years of Coding experience REQUIRED
- Prior leadership experience managing a pre-pay review team, including oversight of pre-payment claim reviews, provider monitoring activities, medical record reviews, and payment integrity operations within a healthcare payer environment.
Responsibilities
- Managing a team of Special Investigative Unit (SIU) Investigators across multiple states.
- Reporting findings to appropriate government and regulatory agencies.
- Extensive interaction with various internal departments, providers, and government agencies.
- Reviewing and proposing updates to health plan rules and policies as they relate to fraud, waste, and abuse.
- Providing compliance advice and assisting with organizational change and compliance interpretation as it relates to fraud, waste, and abuse.
- Leading the monthly FWA subcommittee meeting.
Benefits
- Medical, Dental, Vision plans
- Adoption, Fertility and Surrogacy Reimbursement up to $10,000
- Paid Time Off and Sick Leave
- Paid Parental & Family Caregiver Leave
- Emergency Backup Care
- Long-Term, Short-Term Disability, and Critical Illness plans
- Life Insurance
- 401k/403B with Employer Match
- Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
- Student Debt Pay Down – $10,000
- Pet Insurance
- Legal Resources Plan
- Annual discretionary bonus if established system and employee eligibility criteria is met.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
