Special Investigation Unit Manager - Clinical Certified Professional Coder

December 25, 2024

🇺🇸 United States – Remote

🦌 Connecticut – Remote

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

🥔 Idaho – Remote

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

+2 more states

🦌 Connecticut – Remote 🥔 Idaho – Remote 🦬 Montana – Remote 🎸 Mississippi – Remote

💵 $54.3k - $159.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💻 IT Support

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CVS Health

WebsiteLinkedInAll Job Openings

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

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Description

• Lead and mentor a team of certified coders supporting fraud detection and prevention. • Establish team goals, monitor performance, and ensure alignment with objectives. • Direct and oversee complex reviews and ensure timely reporting of review findings. • Conduct evaluations and provide performance feedback to staff. • Manage workload and ensure equitable distribution of cases. • Confirm comprehensive reporting of investigation outcomes. • Ensure compliance with regulations.

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. • Preferred: Registered Nurse (RN) and previous leadership experience. • Additional AAPC Coding Certifications preferred.

Benefits

• Full range of medical, dental, and vision benefits. • 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 discount programs with partners. • Paid Time Off (PTO) or vacation pay. • Paid holidays throughout the calendar year.