Manager, Special Investigative Unit(Texas)

About the role

Job Description Leads and manages team responsible for special investigation unit (SIU) activities, specifically the prevention and detection of violation of applicable laws and regulations. Responsible to protect the business from liability of fraudulent or abusive practices, and ensure the business understands and complies with applicable laws and regulations pertaining to the health care environment.

Responsibilities

• Provides oversight and review of the special investigation until (SIU) referral intake and investigation process, and provides guidance and direction to team on case investigation steps/actions.
• Collaborates with leadership to maintain and revise policies and procedures, fraud, waste, and abuse (FWA) plans, annual audit work plans - including department guidance memos, and educational materials.
• Identifies opportunities for improvement through the audit process and provides recommendations for system enhancements in order to augment investigative outcomes and performance.
• Accurately tracks, reports, and follows-up on overpayments and recoveries.

• Requirements

  • At least 7 years of experience in special investigations, law enforcement, and/or experience in a regulatory environment, or equivalent combination of relevant education and experience.
  • At least 1 year of management/leadership experience.
  • Strong interpersonal skills.
  • Strong analytical and critical-thinking abilities.
  • Organizational and time-management skills.
  • Experience with investigative case management system.
  • Strong verbal and written communication skills.
  • Microsoft Office suite/applicable software program(s) proficiency.

  Qualifications

  • Health Care Anti-Fraud Associate (HCAFA), Accredited Health Care Fraud Investigator (AHFI) and/or Certified Fraud Examiner (CFE).

  Pay

  Pay Range: $73,102 - $142,549 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.