Special Investigation Unit Manager Clinical Certified Professional Coder (Aetna SIU)

Are you a highly skilled and knowledgeable Clinical Certified Professional Coder looking for a new and exciting opportunity? Aetna, one of the leading healthcare companies in the nation, is seeking a Special Investigation Unit (SIU) Manager to join our team. In this role, you will be responsible for managing and overseeing our SIU team, ensuring compliance with coding guidelines and regulations. This is a unique and challenging position where you will have the opportunity to use your expertise and leadership skills to make a positive impact on our organization. We are looking for a driven and motivated individual who is passionate about healthcare and has a strong background in medical coding. If you are ready for a new challenge and want to be a part of a dynamic and innovative team, we encourage you to apply for this position. Manage and oversee the Special Investigation Unit (SIU) team, providing direction and guidance to ensure efficient and effective operations. Ensure compliance with coding guidelines and regulations, including the Health Insurance Portability and Accountability Act (HIPAA). Use your expertise and knowledge of medical coding to identify and investigate potential fraud, waste, and abuse in healthcare claims. Develop and implement strategies to prevent and detect fraudulent activities within the company. Collaborate with internal and external stakeholders, including law enforcement and regulatory agencies, to facilitate investigations and resolve issues. Stay up-to-date on industry changes and updates related to medical coding regulations and guidelines. Lead and participate in training and development programs for the SIU team and other members of the organization. Monitor and analyze coding trends to identify potential areas of risk and make recommendations for improvement. Prepare reports and presentations on findings and recommendations for senior management. Act as a liaison between the SIU team and other departments within the organization to ensure effective communication and collaboration. Uphold ethical standards and maintain confidentiality in handling sensitive information. Represent the company in meetings and conferences related to medical coding and fraud prevention. Maintain accurate and organized records of investigations and outcomes. Foster a positive and professional work environment within the SIU team, promoting teamwork and continuous learning. Adhere to all company policies and procedures, as well as relevant laws and regulations. Aetna is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Apply tot his job