Special Investigation Unit (SIU) Manager

Certified Professional Coder (CPC) ManagerWe're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.The Certified Professional Coder (CPC) Manager will oversee a team of medical coders within the Special Investigations Unit (SIU) to ensure compliance with coding practices through comprehensive record reviews for medical, behavioral, transportation, and other healthcare providers.Role Overview:The CPC Manager will be responsible for guiding the team in determining correct coding and appropriate documentation during the review of medical records. This role requires a strong focus on meeting state, federal, and company requirements while identifying concerning billing patterns or trends.• Lead and mentor a team of CPCs, providing training, guidance, and support in coding practices and medical record reviews.• Conduct regular audits of team performance to ensure compliance with CPT/HCPCS coding and documentation standards.• Establish team goals, monitor performance, and ensure alignment with organizational objectives.• Direct and oversee complex coding reviews and resolve intricate issues with sensitivity, including claim reviews for legal, compliance, or rework projects.• Ensure staff provide detailed written summaries of medical record review findings and ensure the team articulates findings effectively to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, and state regulators.• Conducts team member evaluations and provides performance feedback to staff on an ongoing basis.• Collaborate with Medical Directors to validate decisions and discuss complex cases.• Manages workload of their team to ensure equitable distribution and exposure to wide range of cases to match current skills and development needs.• Assist with investigative research related to coding questions, state and federal policies, and identify potential billing errors, abuse, and fraud.• Identify opportunities for savings related to potential cases that may warrant a prepayment review.• Maintain appropriate records, files, and documentation for the team.• Utilize department resources effectively and ensure workflows are followed to meet performance metrics.• Collaborate with investigators, data analytics, and plan leadership on SIU schemes and initiatives.• Act as the primary point of contact for the team in the absence of the director, ensuring continuity of operations and support.• Develop and implement training and onboarding programs for new team membersRequirements:• AAPC Coding certification.• 5+ years of experience in medical coding or documentation auditing• Strong knowledge of standard industry coding guides and guidelines, including CPT, HCPCS, ICD-10, CMS 1500, and UB04 data elements.• Maintains up-to-date coding knowledge, including new changes to coding compliance and reimbursement.• Experience with researching coding and policies.• Proficiency in Microsoft products, particularly Excel and Word.• Strong attention to detail and ability to review and interpret data.• Demonstrates strong communication and leadership skills.• Excellent analytical skills and the ability to mentor and develop team members.Preferred:3 + years in a role with direct people management2+ years experience in an SIU team lead role or equivalentPrior medical record review within a payer experience is preferred.Anticipated Weekly Hours: 40Time Type: Full timePay Range: The typical pay range for this role is:$54,300.00 - $159,120.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.