[Hiring] Manager, Special Investigative Unit @Sentara Health

Role Description

Sentara Health Plan is currently hiring a Manager, Special Investigative Unit/ Program Integrity / CPC - Remote!

• Status: Full-time, permanent position (40 hours)
• Work hours: 8am to 5pm EST, M-F
• Remote opportunities available in multiple states with travel to Virginia Beach 1x a year.

Position is responsible for:

• 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 related to fraud, waste, and abuse.
• Providing compliance advice and assisting with organizational change and compliance interpretation.
• Leading the monthly FWA subcommittee meeting.

Qualifications

• Bachelor’s degree (REQUIRED)
• Certified Professional Coder (CPC) (REQUIRED)

Requirements

• 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.

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 opportunity if established criteria is met.