Special Investigation Unit Manager

Job not on LinkedIn

🕒 October 5

🌵 Arizona, California, +16 more states – Remote

🌵 Arizona – Remote 🏄 California – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🦞 Maine – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🏈 Ohio – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote ⚓ Rhode Island – Remote 🎸 Tennessee – Remote ⚔️ Virginia – Remote

💵 $54.3k - $159.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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 • Guide the team in determining correct coding and appropriate documentation during medical-record reviews • Ensure compliance with state, federal, and company requirements • Identify concerning billing patterns or trends • Lead, mentor, train, and support CPCs • Audit team performance for CPT/HCPCS coding and documentation compliance • Establish team goals and monitor performance • Direct complex coding reviews and resolve intricate issues • Ensure detailed written summaries of medical-record review findings • Communicate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, and state regulators • Conduct team-member evaluations and provide ongoing feedback • Collaborate with Medical Directors on complex cases • Manage workload distribution and team development exposure • Research coding questions and policies and identify potential billing errors, abuse, and fraud • Identify potential savings opportunities warranting prepayment review • Maintain team records, files, and documentation • Ensure workflows and performance metrics are followed • Collaborate with investigators, data analytics, and plan leadership on SIU schemes and initiatives • Serve as primary team contact in the director’s absence • Develop and implement training and onboarding programs

🎯 Requirements

• AAPC Coding certification • 5+ years of experience in medical coding or documentation auditing • Strong knowledge of CPT, HCPCS, ICD-10, CMS 1500, and UB04 data elements • Up-to-date coding knowledge, including changes to coding compliance and reimbursement • Experience researching coding and policies • Proficiency in Microsoft products, particularly Excel and Word • Strong attention to detail and ability to review and interpret data • Strong communication and leadership skills • Excellent analytical skills and ability to mentor and develop team members • 3+ years in a role with direct people management preferred • 2+ years of experience in an SIU team lead role or equivalent preferred • Prior medical record review within a payer experience preferred

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being