Louisiana Licensed SIU Manager (49)

Summary

To manage strategic fraud, waste, and abuse activities, the full-time Louisiana Licensed SIU Manager will develop and implement compliance measures, lead investigations into fraud 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 possible 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 terminologyPrevious experience in a managed care environment and as a lead or supervisor preferredKnowledge of Microsoft Excel, medical coding, claims processing, and data mining preferred

Job Description

To manage strategic fraud, waste, and abuse activities, the full-time Louisiana Licensed SIU Manager will develop and implement compliance measures, lead investigations into fraud 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 possible 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 terminologyPrevious experience in a managed care environment and as a lead or supervisor preferredKnowledge of Microsoft Excel, medical coding, claims processing, and data mining preferred