Mgr Special Investigations Unt
Apply NowCompany: Texas Children's Health Plan
Location: Bellaire, TX 77401
Description:
Details
Client Name
Texas Children's Health Plan
Job Type
Travel
Offering
Non-Clinical
Profession
Non-Clinical
Specialty
Other
Job ID
31720996
Job Title
Mgr Special Investigations Unt
Weekly Pay
$2576.0
Shift Details
Shift
Day - 8x5 - 09AM
Scheduled Hours
40
Job Order Details
Start Date
05/19/2025
End Date
08/16/2025
Duration
13 Week(s)
Job Description
Job Title: Manager, Special Investigations Unit
Profession: Management
Specialty: Special Investigations
Duration: 13 months
Shift: Hybrid or remote
Hours per Shift: 40
Experience:
- 8 years of experience in fraud, waste, and abuse (FWA) investigations or special investigations unit (SIU) including 1 year of experience working with Medicaid.
License:
- High School Diploma or GED OR Bachelor's Degree
Certifications:
- One of the following certifications is required:
- CPA - Certified Public Accountant
- CFA - Certified Fraud Examiner
- AHFI - Accredited Health Care Fraud Investigator
- INT-POPC - Intermediate Peace Officer Proficiency Certificate
Must-Have:
- Strong analytical and research skills.
- Proficient in researching information and identifying resources.
- Knowledge of medical terminology and experience with CPT codes and ICD-9, ICD-10 coding.
- Strong communication and customer service skills.
Description:
Responsible for the oversight of the Special Investigations Unit (SIU) and Fraud, Waste, and Abuse (FWA) program in compliance with contractual and regulatory requirements.
Oversees case management, case investigation, overpayment recoveries, and reporting of investigations to regulatory agencies.
Responds to government requests for information related to FWA.
Facilitates compliance with state and federal FWA requirements.
Develops and maintains employee education.
Identifies new recovery opportunities, goals, and sound practices.
Coordinates with subcontractors on overseeing investigations of Fraud, Waste, and Abuse (FWA).
Manages a large fraud investigation caseload and investigates allegations relating to potential health care fraud.
Provides internal and external case updates on the progression of investigations in coordination with SIU team members and other departments.
Makes recommendations on further action and/or resolution as needed.
Interfaces with members, vendors, pharmacies, providers, and other third parties via telephone, e-mail, and on-site visits to identify and conclude ongoing investigations.
Implements processes and procedures to prevent, detect, investigate, and report FWA to appropriate regulatory agencies.
Provides inter-departmental input regarding controls for preventing and monitoring FWA issues.
Proactively identifies trends and aberrant activity to generate leads for FWA investigations.
Performs special assignments related to FWA as assigned by the Director of Controls and Compliance.
Demonstrates experience with a health plan and understands the components and functions of an SIU.
Client Details
Address
6330 W Loop S
City
Bellaire
State
TX
Zip Code
77401
Job Board Disclaimer
By applying for jobs on this website, you consent to receive daily messages from CYNET about assignments that match your profile. Email or text HELP for more info, or STOP to unsubscribe.
Your mobile info will not be shared with third parties for marketing. Standard messaging and data rates may apply.
Client Name
Texas Children's Health Plan
Job Type
Travel
Offering
Non-Clinical
Profession
Non-Clinical
Specialty
Other
Job ID
31720996
Job Title
Mgr Special Investigations Unt
Weekly Pay
$2576.0
Shift Details
Shift
Day - 8x5 - 09AM
Scheduled Hours
40
Job Order Details
Start Date
05/19/2025
End Date
08/16/2025
Duration
13 Week(s)
Job Description
Job Title: Manager, Special Investigations Unit
Profession: Management
Specialty: Special Investigations
Duration: 13 months
Shift: Hybrid or remote
Hours per Shift: 40
Experience:
- 8 years of experience in fraud, waste, and abuse (FWA) investigations or special investigations unit (SIU) including 1 year of experience working with Medicaid.
License:
- High School Diploma or GED OR Bachelor's Degree
Certifications:
- One of the following certifications is required:
- CPA - Certified Public Accountant
- CFA - Certified Fraud Examiner
- AHFI - Accredited Health Care Fraud Investigator
- INT-POPC - Intermediate Peace Officer Proficiency Certificate
Must-Have:
- Strong analytical and research skills.
- Proficient in researching information and identifying resources.
- Knowledge of medical terminology and experience with CPT codes and ICD-9, ICD-10 coding.
- Strong communication and customer service skills.
Description:
Responsible for the oversight of the Special Investigations Unit (SIU) and Fraud, Waste, and Abuse (FWA) program in compliance with contractual and regulatory requirements.
Oversees case management, case investigation, overpayment recoveries, and reporting of investigations to regulatory agencies.
Responds to government requests for information related to FWA.
Facilitates compliance with state and federal FWA requirements.
Develops and maintains employee education.
Identifies new recovery opportunities, goals, and sound practices.
Coordinates with subcontractors on overseeing investigations of Fraud, Waste, and Abuse (FWA).
Manages a large fraud investigation caseload and investigates allegations relating to potential health care fraud.
Provides internal and external case updates on the progression of investigations in coordination with SIU team members and other departments.
Makes recommendations on further action and/or resolution as needed.
Interfaces with members, vendors, pharmacies, providers, and other third parties via telephone, e-mail, and on-site visits to identify and conclude ongoing investigations.
Implements processes and procedures to prevent, detect, investigate, and report FWA to appropriate regulatory agencies.
Provides inter-departmental input regarding controls for preventing and monitoring FWA issues.
Proactively identifies trends and aberrant activity to generate leads for FWA investigations.
Performs special assignments related to FWA as assigned by the Director of Controls and Compliance.
Demonstrates experience with a health plan and understands the components and functions of an SIU.
Client Details
Address
6330 W Loop S
City
Bellaire
State
TX
Zip Code
77401
Job Board Disclaimer
By applying for jobs on this website, you consent to receive daily messages from CYNET about assignments that match your profile. Email or text HELP for more info, or STOP to unsubscribe.
Your mobile info will not be shared with third parties for marketing. Standard messaging and data rates may apply.