Job Description

Job Description

City/State

Richmond, VA

Overview

Work Shift

First (Days) (United States of America)

Virginia Premier Health Plan Richmond is hiring a Remote Team Coordinator, SIU

The Remote Team Lead, SIU supervises the investigation function for an office, group or customer. Supervises the work of Investigative team including all levels of investigations, Medical Review and/or support staff. Ensures all complaints, leads and investigations are monitored, thoroughly worked and documented. Interface with regulatory agencies both state and federal. Extensive knowledge of Medicare, Medicaid program laws, regulations, resources and documentation. Creates and implements well defined work processes, establishes priorities, monitors and distributes workload. Creates and conducts investigation-related training. Foster relationships with and collaborate with business segments in organization. Supports legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions. Negotiates settlement agreements to resolve disputes. Participates in special projects as required.

Remote opportunities available in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisc onsin, Wyoming

Requirements:
Bachelor's Degree required. Degree in a related field of study preferred.
5-8 years of related investigative experience in health care required.
2 + years of leadership experience such as project leadership, team lead or similar roles strongly preferred.
Prior experience directly supervising staff is a plus.
Certified Professional Coder required (or achieved within 12 months of hire date) AND AHFI required (or achieved within 24 months of date of hire).

(Note: Federal Agents who have successfully completed the Federal Bureau of Investigation Training Program (FBITP) - Criminal Investigator Training Program (CITP) would be considered equivalent to the Accredited Health Care Fraud Investigator (AHFI)

Preferred Qualifications:
Certified Fraud Specialist (CFS
Certified Professional Coder (CPC
Certified Forensic Interviewer (CFI)
Certified in Healthcare Compliance (CHC).

Our Benefits:

As the third-largest employer in Virginia, Sentara Health was named by Forbes Magazine as one of America's best large employers. We offer a variety of amenities to our employees, including, but not limited to:

Medical, Dental, and Vision Insurance
Paid Annual Leave, Sick Leave
Flexible Spending Accounts
Retirement funds with matching contribution
Supplemental insurance policies, including legal, Life Insurance and AD&D among others
Work Perks program including discounted movie and theme park tickets among other great deals
Opportunities for further advancement within our organization

Sentara employees strive to make our communities healthier places to live. We are setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For information about our employee benefits, please visit: Benefits - Sentara (sentaracareers.com)

Sentara Health offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind. Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave. Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.

For applicants within Washington and Maryland State, the following hiring range will be applied: $76,003.20 annually to $104,897.52 annually

Keywords: Talroo-health Plan, #ZipRecruiter, Coding, Internal/External Auditing, leadership, AHFI, CPC

Job Summary

Supervises the investigation function for an office, group or customer. Supervises the work of Investigative team including all levels of investigations, Medical Review and/or support staff. Ensures all complaints, leads and investigations are monitored, thoroughly worked and documented. Interface with regulatory agencies both state and federal. Extensive knowledge of Medicare, Medicaid program laws, regulations, resources and documentation. Creates and implements well defined work processes, establishes priorities, monitors and distributes workload. Creates and conducts investigation-related training. Foster relationships with and collaborate with business segments in organization. Supports legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions. Negotiates settlement agreements to resolve disputes. Participates in special projects as required.

Bachelor's Degree required. Degree in a related field of study preferred.

5-8 years of related investigative experience in health care required.

2 + years of leadership experience such as project leadership, team lead or similar roles strongly preferred.

Prior experience directly supervising staff is a plus.

Certified Professional Coder required (or achieved within 12 months of hire date) AND AHFI required (or achieved within 24 months of date of hire).

(Note: Federal Agents who have successfully completed the Federal Bureau of Investigation Training Program (FBITP) - Criminal Investigator Training Program (CITP) would be considered equivalent to the Accredited Health Care Fraud Investigator (AHFI)

Preferred Qualifications:
1. Certified Fraud Specialist (CFS)
2. Certified Professional Coder (CPC)
3. Certified Forensic Interviewer (CFI), or
4. Certified in Healthcare Compliance (CHC).

Qualifications:

BLD - Bachelor's Level Degree (Required)

Certified Professional Coder (CPC) - Certification - American Academy of Professional Coders (AAPC)

Leadership, Related experience

Skills

Active Learning, Active Listening, Communication, Complex Problem Solving, Coordination, Critical Thinking, Judgment and Decision Making, Leadership, Mathematics, Mgmt of Staff Resources, Microsoft Excel, Microsoft Word, Monitoring, Project Management, Quality Control Analysis, Reading Comprehension, Service Orientation, Social Perceptiveness, Speaking, Technology/Computer, Time Management, Troubleshooting, Writing

Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

In support of our mission "to improve health every day," this is a tobacco-free environment.

Job Tags

Remote job, Flexible hours, Shift work,

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