Special Investigation Unit (SIU) Manager
Core
Lead a team of Certified Professional Coders (CPCs) to conduct comprehensive medical record reviews, identify billing patterns, and ensure compliance with coding practices for medical, behavioral, and transportation healthcare providers.
Role type
Senior IC medical coding manager (SIU)
Builds
Compliance audits and investigative reports on billing patterns and potential fraud/abuse
Domain
Healthcare administration / Medical coding compliance
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Medical coding (CPC), CPT/HCPCS/ICD-10 guidelines, claim review, team leadership, performance auditing, policy research, data interpretation, Microsoft Excel/Word
Preferred skills
Prior auditing experience, investigative research
Technologies
CPT, HCPCS, ICD-10, CMS 1500, UB04, Microsoft Excel, Microsoft Word
Responsibilities
Lead and mentor a team of CPCs in coding practices and medical record reviews; Conduct regular audits of team performance to ensure compliance with coding standards; Establish team goals and monitor performance; Direct complex coding reviews and resolve intricate billing issues; Ensure staff provide detailed written summaries of findings for investigators and regulators; Conduct team member evaluations and provide performance feedback; Collaborate with Medical Directors to validate decisions on complex cases; Manage team workload for equitable distribution; Assist with investigative research on coding questions and billing errors; Identify opportunities for savings related to prepayment reviews; Maintain team records and documentation; Utilize department resources to meet performance metrics; Collaborate with investigators and data analytics on SIU initiatives; Act as primary point of contact for the team in the director's absence; Develop and implement training and onboarding programs.
Seniority
Senior, hands-on IC with leadership responsibilities