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Supervisor, Special Investigations Unit

Company: Cenpatico
Location: Chesterfield
Posted on: November 7, 2019

Job Description:

Supervisor, Special Investigations Unit USA-Missouri-Chesterfield Position Purpose: Supervise the Special Investigation Unit staff to ensure accurate, timely, and efficient reporting related to SIU business functions. Responsible for ensuring all investigative timelines and processes are compliant with internal company and state guidelines. * Review preliminary waste, abuse, and fraud reports completed by special investigation unit investigators. * Provide final reports, summaries, and recommendations to health plans and external regulators * Review reports and analysis prepared by special investigation unit analysts to validate data integrity and evaluate if investigation is warranted * Monitor cases in case tracking system (HCFS) to ensure investigations are progressing accurately, timely and in compliance with state guidelines. * Recommend changes to the investigative process as needed * Develop new investigative leads by analyzing data trends and developing new reports and queries to identify instances of potential fraud, waste, and abuse * Evaluate cases and recommend changes to investigative policies and procedures to enhance member outcomes by addressing patient safety concerns and enhancing return on investment * Assist with collection and review of information for state investigators including data requests or any investigative materials associated with subpoenas from law enforcement agencies or state regulators * Oversee, train, and mentor special investigation unit investigators and analysts Experience/Experience: * Bachelor s degree in Business, Healthcare, Criminal Justice, related field, or equivalent experience. * 3+ years of medical claim or fraud investigation experience. * Knowledge of Excel, medical coding, claims processing, and data mining preferred. * Previous experience as a lead in a functional area or managing cross functional teams on large scale projects preferred. License/Certification: Medical records or coding license preferred. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Compliance Full-time

Keywords: Cenpatico, Chesterfield , Supervisor, Special Investigations Unit, Other , Chesterfield, Missouri

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