SIU Compliance Manager
About The Position
RGP is seeking an SIU Compliance Manager to provide additional Special Investigations Unit support for a healthcare payer client handling a heavy caseload of fraud, waste, and abuse (FWA) investigations. The role supports compliance with state and federal regulations and helps ensure claims integrity. This is a fully remote, full-time project opportunity lasting 6–12 months, with pay of $45–$60 per hour on W-2 plus benefits. The manager reviews medical records, claims, and supporting materials for clinical consistency, completeness, and compliance; assesses potential fraud, waste, and abuse; and evaluates medical necessity and the appropriateness of billed services. The role works with SIU investigators and leadership, documents findings, and recommends further review or action. Relevant experience may include healthcare investigations, compliance, SIU, clinical auditing, utilization review, medical record review, or related healthcare oversight. A clinical background is strongly preferred.
Requirements
- Experience in healthcare investigations, healthcare compliance, SIU, clinical auditing, utilization review, medical record review, or related healthcare oversight functions.
- Strong understanding of medical necessity criteria and healthcare documentation standards.
- Knowledge of healthcare fraud schemes, billing practices, and claims review methodologies.
- Experience reviewing complex medical records and identifying documentation discrepancies.
- Ability to analyze clinical information and communicate findings effectively.
Nice To Haves
- Clinical background strongly preferred.
- Experience in healthcare payer, managed care, SIU, fraud investigations, clinical auditing, or healthcare compliance environments is highly desirable.
Responsibilities
- Review medical records, claims, and supporting documentation for clinical consistency, completeness, and compliance.
- Identify potential fraud, waste, and abuse indicators, including cloned medical documentation, upcoding, billing inconsistencies, unsupported services or procedures, and medical necessity concerns.
- Conduct initial reviews and assessments of complex healthcare cases to determine potential compliance risks.
- Analyze documentation to validate medical necessity and the appropriateness of billed services.
- Collaborate with SIU investigators and leadership to support ongoing investigations.
- Document findings and provide clear recommendations for further review or action.
- Stay informed about healthcare regulations, billing guidelines, and industry best practices.
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- Life insurance
- Disability insurance
- 401(k) Savings Plan
- Employee Stock Purchase Plan
- Professional Development Program
- Paid Time Off
- Paid Sick Time in geographies where legally required
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
