Special Investigation Unit Manager - Clinical Certified Professional Coder

March 1

🥔 Idaho – Remote

Although this job is listed in Idaho, this company may be open to hiring remote in other states.

🔔 Pennsylvania – Remote

Although this job is listed in Pennsylvania, this company may be open to hiring remote in other states.

💵 $54.3k - $159.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💻 IT Support

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CVS Health

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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.

Retail • Pharmacy Benefits Management • Health Insurance • Health Care • Pharmacy

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

📋 Description

• Lead and mentor a team certified coders for fraud detection. • Establish team goals and monitor performance. • Direct complex reviews and report findings. • Conduct team evaluations and provide feedback. • Manage workload and ensure compliance with regulations. • Train staff to maintain CEUs. • Assist in preparing documentation for audits and compliance reviews.

🎯 Requirements

• Minimum 5+ years of experience in healthcare fraud detection, investigation, or auditing. • In-depth knowledge of healthcare systems, claims processing, and regulatory requirements. • Proficient in researching information and identifying information resources. • AAPC Coding certification - Certified Professional Coder (CPC). • Strong leadership and team management ability. • Excellent communication and presentation skills. • Ability to work cross-functionally with various teams and external partners. • Ability to travel for business needs.

🏖️ Benefits

• Full range of medical, dental, and vision benefits. • Eligible for 401(k) retirement savings plan. • Employee Stock Purchase Plan available. • Fully-paid term life insurance plan. • Short-term and long-term disability benefits. • Well-being programs and education assistance. • Free development courses. • CVS store discount and partner discount programs. • Paid Time Off (PTO) and paid holidays.