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Corporate SIU Coordinator in Chesapeake, VA at Beacon Health Options

Date Posted: 3/7/2019

Job Snapshot

Job Description

About The Position:

The Corporate SIU Coordinator is responsible for assisting in the implementation of the Corporate Fraud, Waste and Abuse Plan and related activities under the direction of the Director, Corporate SIU.  Operates as a primary resource for Beacon Health Options (Beacon) and contact for provider monitoring and provider audit related activities.

Position Responsibilities:

  • Gather preliminary documentation and pull provider claims/charts in preparation for audit, as directed by the Director, Corporate SIU.
  • Issue routine and form correspondence to providers as part of the audit program.
  • Coordinate recoveries/claims recoupments from providers and track completion of provider corrective action plans.
  • Maintain accurate and timely data and reports.  Review/prepare provider audit files for closure and storage.
  • Conduct data-mining and data analysis to identify outliers/potential fraud, waste and abuse.
  • Offer training and technical direction for providers and assist the Director, Corporate SIU in the identification of training needs. Participate in communication and training sessions for providers when appropriate.
  • Participate on special projects, committees, and task forces and perform other duties as assigned.
  • Foster and maintain positive relationships with representatives of Beacon’s core functions, policyholders, law enforcement, clients, providers, and the general public.
  • Serves as a role model for compliant behavior and integrity, consistent with the mission, vision and values of Beacon, and as an internal authority on applicable audit standards.

Position Requirements:

  • Education: Some secondary education in health care, accounting, management or law enforcement field required. Bachelor’s degree preferred.
  • Licenses: If degree is in healthcare, then current state licensure as results from the degree program, e.g., RN, LPN, Physician Assistant, or CRNP, etc.

Relevant Work Experience:

  • Minimum of two years of experience in healthcare, accounting (public or private), or healthcare coding and auditing, with preference given to candidates with this experience in a managed care environment.
  • In addition, at least one year of experience is required in fraud and abuse and/or white collar crime investigations and one to two years of experience in healthcare claims preferred.

To Apply:

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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled