Special Investigation Unit (SIU) Coding Review Manager

No detailed description available.

• Lead and mentor a team of CPCs providing training guidance and support in coding practices and medical record reviews
• Conduct regular audits of team performance ensuring compliance with CPT/HCPCS coding documentation standards
• Establish team goals monitoring performance ensuring alignment with organizational objectives
• Direct oversee complex coding reviews resolving intricate issues with sensitivity including claim reviews for legal compliance or rework projects
• Ensure staff provide detailed written summaries of medical record review findings ensuring the team articulates findings effectively investigators Medicaid plan leadership law enforcement legal counsel providers state regulators
• Conduct team member evaluations providing performance feedback staff on an ongoing basis
• Collaborate with Medical Directors validating decisions discussing complex cases
• Manage workload team ensuring equitable distribution exposure to wide range of cases matching current skills development needs
• Assist investigative research related coding questions state federal policies identifying potential billing errors abuse fraud
• Identify opportunities savings related potential cases warranting prepayment review
• Maintain appropriate records files documentation team
• Utilize department resources effectively ensuring workflows followed meet performance metrics
• Collaborate investigators data analytics plan leadership SIU schemes initiatives
• Act primary point contact team absence director ensuring continuity operations support
• Develop implement training onboarding programs new team members

• Minimum 2 years managing staff
• Coding Certification CPC CPMA COC
• Minimum 5 years experience medical record review coding accuracy
• Strong knowledge standard industry coding guides guidelines including CPT HCPCS ICD-10 CMS data elements
• Maintains up-date coding knowledge including changes compliance reimbursement
• Experience researching coding policies
• Proficiency Microsoft products particularly Excel Word
• Strong attention detail ability review interpret data
• Demonstrates strong communication leadership skills

• Affordable medical plan options
• 401(k) plan including matching company contributions
• Employee stock purchase plan
• No-cost programs including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
• Benefit solutions including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility