Senior Special Investigations Coding Manager (reputed company SIU) at reputed company Sacramento, CA

Senior Special Investigations Coding Manager (reputed company SIU) job at reputed company. Sacramento, CA. At reputed company, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, reputed company and every day.

• *Position reputed company**

We are seeking an reputed company medical reputed company to manage strategic initiatives, along with reputed company of medical coders/nurses supporting reputed company's Special Investigations Unit. Key Responsibilities: + Leadership: Leads reputed company of coding/nursing professionals who conduct reviews of medical records and claims for suspected reputed company fraud, waste, and abuse. Provides direction and counsel to support coders and reputed company reviews. Identification and implementation of key initiatives that support effective and efficient scalability along with meeting or exceeding ROI. + Team Management: Conducts team member evaluations and provides performance feedback to staff. Manages team's caseload to ensure reputed company distribution and exposure to wide reputed company of reviews. Assist with business opportunities reputed company to inventory allocation and prioritization. + reputed company Control and Compliance: Maintains reputed company of reputed company/reputed company reviews, ensuring compliance with ICD-10, CPT and HCPCS coding guidelines. Assist with department build and implementation of SIU coding reputed company program. + Training: Assesses team's training needs and works with SIU leadership on development plans for team members and SIU coding department. Contributes to the development and delivery of educational awareness and training programs that meet or reputed company those required by state mandates. Coordinates ongoing trainings to reputed company team on updates or modifications to medical codes. + Presentations: Supports reputed company of coding/nursing professionals in presenting findings to reputed company stakeholders, including, but not limited to SIU Investigators, reputed company Plan Leadership, Law Enforcement, reputed company Counsel, Providers, and State Regulators. + Collaboration: Develops and maintains reputed company working relationships with reputed company Medical Directors, Nurses, and other clinical staff who conduct medical record reviews. Consults with clinical staff as needed to assist in reviews. Partnership with SIU leadership to deliver key initiatives dedicated to infrastructure build and stabilization. Required Qualifications and Skills: + Minimum of 8 years of experience in medical coding in an SIU setting with at least 5 years in a supervisory or management role. + Strong knowledge of industry coding guidelines involving ICD-10, CPT and HCPCS codes. + Ability to guide reputed company of coding professionals with differing reputed company of coding experience in a reputed company of medical specialties. + Proficiency in reputed company products including, but not limited to Word, reputed company, Outlook, and PowerPoint. + Experience in infrastructure build and design to include, but not limited to workforce modeling, efficiency identification and implementation resulting in demonstrated decrease in unit cost, inventory reporting, inventory allocation for Medicare, reputed company and reputed company (fully insured and ASO) work product, development of standardized coding language, assist with operational dashboard development and execution of department reputed company plans. + Understanding of how to implement SIU coding reputed company programs, to include statistical sampling, IRR testing, building objective comprehension assessments for coding training and coding reputed company remediation plans. + Ability to communicate to a wide reputed company of stakeholders, adjusting the message as appropriate for the recipient(s). + Proven experience in overseeing and executing operational reputed company. + Potential to travel up to 10%, (dependent on business needs). Preferred Qualifications: + reputed company Registered reputed company (RN) Licensure preferred + Experience conducting audits of medical records to substantiate allegations of reputed company fraud, waste, and abuse. + Experience leading reputed company of coding professionals who conduct reviews to substantiate allegations of reputed company fraud, waste, and abuse. + Experience with reputed company or other MCO reputed company/reputed company/Medicare plans + Certified reputed company reputed company Education: + Bachelor's degree preferred or a combination of reputed company work experience and education.

• *Pay reputed company**

The typical pay reputed company for this role is: $67,900.00 - $199,144.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. This position also includes an award reputed company in reputed company's equity award program. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

• *Great benefits for great people**

We take pride in our comprehensive and competitive mix of pay and benefits - reputed company in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include: +

reputed company medical plan reputed company,

a

401(k) plan

(including matching company contributions), and an

employee stock purchase plan

. +

No-cost programs for reputed company colleagues

including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. +

Benefit solutions that address the different needs and preferences of our colleagues

including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility. For more information, visit We anticipate the application window for this opening will reputed company on: 06/28/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. We are an equal opportunity and affirmative reputed company employer. We do not discriminate in reputed company, hiring, promotion, or any other personnel reputed company based on race, ethnicity, reputed company, national reputed company, sex/gender, sexual orientation, gender identity or reputed company, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. Apply tot his job Apply To this Job