Special Investigations Un Manager (El Paso Health) Hybrid schedule available - University Medical Center of El Paso

Job Summary
Assists the Chief Compliance/HIPAA Officer (CCO) and Compliance Director in maintaining compliance with the Special Investigations Unit (SIU) requirements enforced by the HHSC Uniform Managed Care Contract, Texas Department of Insurance (TACs/TICs), Office of Inspector General, and Office of Attorney General. Responsible for conducting investigations related to Member and Provider waste, abuse, and fraud (WAF) in El Paso Health’s Medicaid and CHIP programs and educating Providers on appropriate billing guidelines. Oversee all cases, whether conducted in-house or through a contracted SIU. Responsible for the Supervision of the SIU Clerk, SIU Claims Auditor and SIU Registered Nurse.

Skills
1. Ability to follow department and state guidelines in conformity with policies and procedures.
2. Excellent verbal and written communication skills.
3. Proficiency in Microsoft Software.
4. Experience deciphering poor hand-written medical records.
5. Self-starter with the ability to work independently and take initiative.
6. Ability to meet deadlines while producing quality analysis.
7. Highly organized and detailed orientated.
8. Working knowledge of auditing concepts and statistical analysis methods.
9. Ability to analyze and solve problems.
10. Strong presentation skills.

Work Experience
Three years of supervisory/management experience required. Strong experience in the managed care industry with proven working knowledge of Medicare and/or Medicaid. Two years of experience in fraud, waste & abuse (FWA) investigations or special investigations unit (SIU) highly preferred. Experience in medical coding, medical records or billing highly preferred. Knowledge and familiarity with ICD 10, CPT, CMS, HCPCS preferred.

License/Registration/Certification
Certification from the Association of Certified Fraud Examiners (ACFE) highly preferred.

Education and Training
Bachelor degree in Healthcare or Business related field is required.

PI248030438