Special Investigation Unit Manager

Job not on LinkedIn

🔥 16 minutes ago

🌵 Arizona, Idaho, +2 more states – Remote

🌵 Arizona – Remote 🥔 Idaho – Remote 🏈 Ohio – Remote ❄️ Minnesota – Remote

💵 $54.3k - $159.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Oversee a team of medical coders within the Special Investigations Unit (SIU) • Ensure compliance with coding practices through comprehensive record reviews for medical, behavioral, transportation, and other healthcare providers • Guide the team in determining correct coding and appropriate documentation during the review of medical records • Conduct regular audits of team performance to ensure compliance with CPT/HCPCS coding and documentation standards • Establish team goals, monitor performance, and ensure alignment with organizational objectives • Direct and oversee complex coding reviews and resolve intricate issues with sensitivity • Ensure staff provide detailed written summaries of medical record review findings • Conduct team member evaluations and provide performance feedback to staff • Collaborate with Medical Directors to validate decisions and discuss complex cases • Manage workload of the team to ensure equitable distribution and exposure to a wide range of cases • Assist with investigative research related to coding questions, state and federal policies • Identify opportunities for savings related to potential cases that may warrant a prepayment review • Maintain appropriate records, files, and documentation for the team • Utilize department resources effectively and ensure workflows are followed to meet performance metrics • Collaborate with investigators, data analytics, and plan leadership on SIU schemes and initiatives • Act as the primary point of contact for the team in the absence of the director • Develop and implement training and onboarding programs for new team members

🎯 Requirements

• AAPC Coding certification • 5+ years of experience in medical coding or documentation auditing • Strong knowledge of standard industry coding guides and guidelines, including CPT, HCPCS, ICD-10, CMS 1500, and UB04 data elements • Maintains up-to-date coding knowledge, including new changes to coding compliance and reimbursement • Experience with researching coding and policies • 3 + years in a leadership role required • Proficiency in Microsoft products, particularly Excel and Word • Strong attention to detail and ability to review and interpret data • Demonstrates strong communication and leadership skills • Prior auditing experience is preferred • Excellent analytical skills and the ability to mentor and develop team members.

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources based on eligibility