Florida Licensed SIU Manager (51)

Summary

To develop and manage strategic fraud, waste, and abuse activities, the full-time Florida Licensed SIU Manager will monitor compliance in billing and claims payment, lead investigations into referrals, and create educational materials, all while working remotely.Key responsibilitiesMonitor business processes and systems to ensure integrity and compliance in billing and claims paymentLead a team to investigate all potential fraud, waste, and abuse referralsPrepare and distribute monthly and quarterly savings reportsRequired qualificationsBachelor's degree in Business, Healthcare, Criminal Justice, or a related field, or equivalent experience4+ years of experience in medical claim investigation, financial impact analysis, or compliance related to fraud and abuseThorough knowledge of medical terminologyPreferred experience in a managed care environment and supervisory rolesKnowledge of Microsoft Excel, medical coding, and claims processing is preferred

Job Description

To develop and manage strategic fraud, waste, and abuse activities, the full-time Florida Licensed SIU Manager will monitor compliance in billing and claims payment, lead investigations into referrals, and create educational materials, all while working remotely.Key responsibilitiesMonitor business processes and systems to ensure integrity and compliance in billing and claims paymentLead a team to investigate all potential fraud, waste, and abuse referralsPrepare and distribute monthly and quarterly savings reportsRequired qualificationsBachelor's degree in Business, Healthcare, Criminal Justice, or a related field, or equivalent experience4+ years of experience in medical claim investigation, financial impact analysis, or compliance related to fraud and abuseThorough knowledge of medical terminologyPreferred experience in a managed care environment and supervisory rolesKnowledge of Microsoft Excel, medical coding, and claims processing is preferred