City/State

Work Shift

Overview:

Status: Full-time, permanent position (40 hours)

Work hours: 8am to 5pm EST, M-F

Remote opportunities available in the following states: Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming. With travelto Virginia Beach 1x a year.

Job Responsibilities:

• Position is responsible for managing a team of Special Investigative Unit (SIU) Investigators across multiple states.

• Is also responsible for reporting findings to appropriate government and regulatory agencies.

• Position requires extensive interaction with various internal departments as well as providers and government agencies.

• Responsible for reviewing and proposing updates to health plan rules and policies as they relate to fraud, waste and abuse.

• Provides compliance advice and assists with organizational change and compliance interpretation as it relates to fraud, waste and abuse.

• Leads the monthly FWA subcommittee meeting.

Education:

• Bachelors degree REQUIRED

Certifications/Licenses:

• Certified Professional Coder (CPC) REQUIRED

Experience:

• 2 years of Supervisory experience REQUIRED

• Insurance experience REQUIRED

• 5 years of Coding experience REQUIRED

• Candidates must have 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.

We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is: $38.22/hour- $63.70/hour. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

To apply, please go towww.sentaracareers.comand use the following as your Keyword Search:JR-102996

Talroo-Health Plan

Keywords: Healthcare, Health Plan, Remote, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming, Bachelors Degree, Medical Coding, Medical Chart Review, Insurance Billing, Internal/External Audit, Regulatory, Compliance, Claims Investigations, Criminal Investigation, White Collar Crime, Certified Professional Coder (CPC), Fraud, Waste, Abuse, Program Integrity, FWA, PI, SIU, Special Investigations Unit, Manager

Benefits: Caring For Your Family and Your Career

 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 6 $5,250/year and discounted educational opportunities through Guild Education

 Student Debt Pay Down 6 $10,000

Pet Insurance
Legal Resources Plan
Colleagues have the opportunity to earn an annual discretionary bonus ifestablished system and employee eligibility criteria is met.

For positions that are available as remote work, Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.