Special Investigation Unit Manager Clinical Certified Professional Coder (Aetna SIU)

Are you a highly skilled and knowledgeable Clinical Certified Professional Coder looking for a new and exciting opportunity? Aetna, one of the leading healthcare companies in the nation, is seeking a Special Investigation Unit (SIU) Manager to join our team. In this role, you will be responsible for managing and overseeing our SIU team, ensuring compliance with coding guidelines and regulations. This is a unique and challenging position where you will have the opportunity to use your expertise and leadership skills to make a positive impact on our organization. We are looking for a driven and motivated individual who is passionate about healthcare and has a strong background in medical coding. If you are ready for a new challenge and want to be a part of a dynamic and innovative team, we encourage you to apply for this position.

1. Manage and oversee the Special Investigation Unit (SIU) team, providing direction and guidance to ensure efficient and effective operations.
2. Ensure compliance with coding guidelines and regulations, including the Health Insurance Portability and Accountability Act (HIPAA).
3. Use your expertise and knowledge of medical coding to identify and investigate potential fraud, waste, and abuse in healthcare claims.
4. Develop and implement strategies to prevent and detect fraudulent activities within the company.
5. Collaborate with internal and external stakeholders, including law enforcement and regulatory agencies, to facilitate investigations and resolve issues.
6. Stay up-to-date on industry changes and updates related to medical coding regulations and guidelines.
7. Lead and participate in training and development programs for the SIU team and other members of the organization.
8. Monitor and analyze coding trends to identify potential areas of risk and make recommendations for improvement.
9. Prepare reports and presentations on findings and recommendations for senior management.
10. Act as a liaison between the SIU team and other departments within the organization to ensure effective communication and collaboration.
11. Uphold ethical standards and maintain confidentiality in handling sensitive information.
12. Represent the company in meetings and conferences related to medical coding and fraud prevention.
13. Maintain accurate and organized records of investigations and outcomes.
14. Foster a positive and professional work environment within the SIU team, promoting teamwork and continuous learning.
15. Adhere to all company policies and procedures, as well as relevant laws and regulations.

According to JobzMall, the average salary range for a Special Investigation Unit Manager Clinical Certified Professional Coder (Aetna SIU) is $70,000 to $110,000 per year. This range may vary depending on factors such as location, experience, and employer.

Aetna Inc. is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare. Since November 28, 2018, the company has been a subsidiary of CVS Health.