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John F. Kennedy Memorial Hospital

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Manager Special Investigation Unit - Community Health Choice
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 mitigate and remedy FWA. The Manager, SIU develops, implements and manages strategi


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