Special Investigation Unit Coding Director (Aetna SIU)
Are you a highly skilled and experienced coding professional looking for a challenging and rewarding role? Aetna is seeking a dynamic individual to join our team as the Special Investigation Unit Coding Director for our Aetna SIU division. In this role, you will have the opportunity to lead a team of coding specialists in the detection and prevention of healthcare fraud and abuse. We are looking for someone with a passion for coding and a strong background in healthcare fraud detection to help us protect the integrity of our healthcare system. If you are a driven and detail-oriented individual with excellent leadership skills, we want to hear from you!
- Lead a team of coding specialists in the detection and prevention of healthcare fraud and abuse.
- Develop and implement strategies to identify and investigate potential fraudulent activities.
- Conduct regular audits and reviews of coding processes and procedures to ensure compliance with industry standards.
- Collaborate with cross-functional teams to develop and implement fraud prevention measures.
- Analyze coding data and trends to identify potential areas of fraud and abuse.
- Provide guidance and training to team members on coding best practices and fraud detection techniques.
- Stay updated on industry regulations and changes in coding practices to ensure compliance.
- Work closely with law enforcement agencies and legal teams to support investigations and potential legal actions.
- Develop and maintain relationships with external partners and organizations to enhance fraud detection efforts.
- Prepare and present reports and findings to senior management and stakeholders.
- Monitor and evaluate team performance and provide coaching and feedback as needed.
- Identify and implement process improvements to enhance the efficiency and effectiveness of fraud detection efforts.
- Participate in departmental and company-wide meetings and initiatives related to fraud detection and prevention.
- Maintain confidentiality and adhere to company policies and procedures.
- Act as a subject matter expert on coding and healthcare fraud for the organization.
Extensive Coding Knowledge: The Ideal Candidate Should Possess A Thorough Understanding Of Medical Coding Systems, Including Icd-10, Cpt, And Hcpcs Codes. They Should Also Have Experience With Specialty Coding, Such As Fraud And Abuse Coding.
Prior Leadership Experience: The Special Investigation Unit Coding Director Should Have A Proven Track Record Of Successfully Leading A Team Of Coding Professionals. They Should Possess Strong Management Skills And Be Able To Provide Direction And Guidance To Their Team.
Regulatory Compliance Expertise: A Deep Understanding Of Compliance Regulations And Guidelines, Including Hipaa And Medicare Guidelines, Is Essential For This Role. The Candidate Should Also Have Experience With Audits And Investigations Related To Coding Compliance.
Analytical Skills: The Special Investigation Unit Coding Director Should Be Highly Detail-Oriented And Possess Strong Analytical Skills. They Should Be Able To Review And Analyze Complex Medical Records And Coding Data To Identify Potential Fraud, Waste, And Abuse.
Communication And Collaboration: The Candidate Should Have Excellent Communication Skills, Both Written And Verbal, To Effectively Communicate With Team Members, Management, And External Stakeholders. They Should Also Be Able To Collaborate With Other Departments, Such As Legal And Fraud Investigation, To Ensure A Comprehensive Approach To Identifying And Preventing Fraud.
Data Analysis
Compliance Knowledge
Medical Terminology
Team Leadership
Risk assessment
Audit management
Investigative Analysis
Fraud detection
Claim Review
Coding Expertise
Insurance Industry Knowledge
Communication
Conflict Resolution
Emotional Intelligence
Leadership
Time management
creativity
Teamwork
Active Listening
Adaptability
Problem-Solving
According to JobzMall, the average salary range for a Special Investigation Unit Coding Director (Aetna SIU) is $100,000 to $140,000 per year. However, this may vary depending on factors such as location, experience, and company size.
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Aetna Inc. is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare. Since November 28, 2018, the company has been a subsidiary of CVS Health.
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