Manager Special Investigations Unit (SIU)
The SIU identifies, investigates and remediates cases of suspected health care fraud, waste and abuse (FWA), and in coordination with the company's General Counsel, refers cases to the appropriate regulatory agencies and/or law enforcement authorities. The SIU also investigates reports of potential noncompliance with CommunityCare's Code of Conduct and other policies and procedures, as well as possible instances of noncompliance with the company's contractual obligations.
The Manager of the SIU serves as CommunityCare's primary FWA subject matter expert, and is responsible for managing the SIU's daily activities and personnel to ensure appropriate identification and prioritization of potential FWA cases; fostering a professional and collegial working environment through managing, mentoring and directing the individual and team performance of SIU staff; and monitoring progress with performance goals.
- Bachelor' s degree in related field OR equivalent combination of education and work experience required.
- Minimum 5 years' experience conducting FWA investigations and interacting with state, federal and/or local law enforcement authorities.
- Accredited Healthcare Fraud Investigations (AHFI) or Certified Fraud Examiner (CFE) strongly preferred.
- Medical coding certification a plus.
- Advanced knowledge of the managed care industry, government programs (e.g., Medicare and Medicaid), and relevant healthcare anti-fraud laws and regulations.
- Extensive knowledge of investigative techniques, analysis, and reporting.
- High attention to detail and excellent oral and written communication skills.
- Ability to interact effectively inside and outside the organization.
- Strong problem-solving and project planning and management skills.
- Excellent leadership, team-building and strategic thinking.
- Ability to work in a fast-paced environment, often subject to tight deadlines and changing priorities.
- Successful completion of Health Care Sanctions background check.
- Ability to converse and write fluently in English.