Special Investigations Unit (SIU) Program Manager - Remote

Overview

The Special Investigations Unit (SIU) Program Manager will develop, implement, and manage a program to prevent, detect, and investigate suspected fraud, waste, and abuse across Peak Health’s insurance products.

In Short

• Develop and execute annual audit program.
• Manage SIU referral intake and triage process.
• Perform investigations into suspected fraud and abuse.
• Report FWA activity to law enforcement and regulatory agencies.
• Identify opportunities for improvement in audit processes.
• Create and maintain departmental policies and educational materials.
• Collaborate with other departments to educate providers and vendors.
• Track and report on overpayments and recoveries.
• Participate in audit and regulatory reviews.
• Manage relationships with external vendors and consultants.

Requirements

• Bachelor’s degree or equivalent.
• Four years of experience in managed care focusing on payment integrity.
• Preferred: Certified Fraud Examiner (CFE), Accredited Health Care Fraud Investigator (AHFI), Certified Professional Coder (CPC).
• Knowledge of Medicare, Medicaid, and Commercial Coding rules.
• Experience in medical chart review/auditing.
• Ability to use fraud/data mining tools.
• Excellent communication skills.
• Expertise in Microsoft Office products.

Benefits

• Work in a dynamic and collaborative environment.
• Engage in meaningful work that supports healthcare integrity.
• Opportunity to develop professional skills in fraud investigation.
• Standard office environment with reasonable accommodations.