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St. Louis Heart and Vascular

Bridgeton, Missouri

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University of Maryland School of Medicine

Baltimore, Maryland

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Presbyterian Healthcare Services

Albuquerque, New Mexico

UMass Memorial Health-UMass Memorial Medical Center

Worcester, Massachusetts

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University Hospitals Rainbow Babies & Children's Hospital

Cleveland, Ohio

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AdventHealth West Florida Division

Sebring, Florida

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AdventHealth Medical Group West Florida

Davenport, Florida

MUSC Health Tidelands

Murrells Inlet, South Carolina

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AdventHealth

Riverview, Florida

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Geisinger

Danville, Pennsylvania

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AdventHealth

Bolingbrook, Illinois

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UPMC

Hanover, Pennsylvania

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Mgr Special Investigation Unit
JOB SUMMARY: The Manager, SIU manages a team to detect, investigate, remediate and refer to state regulatory agencies and/or law enforcement as appropriate, incidents of fraud, waste and abuse (FWA) arising in connection with medical, behavioral, dental, transportation, pharmacy, and other healthcare services. This position determines correct coding, review claims, review medical records, and billing data from all types of healthcare providers for aberrant billing patterns and is responsible for managing case assignments, case development, case review, overpayment recoveries, managing RFIs, state agency and/or law enforcement referrals, training of staff, and coordination with other departments to mit


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