Navitus Health Solutions is seeking a SIU Associate to join our Compliance department!
The SIU (Special Investigative Unit) Associate I will assist the Compliance and SIU Manager and SIU Team in the execution and maintenance of the Navitus fraud, abuse and waste program, controls, and associated policies and procedures. The SIU Associate I will initiate case files, gather necessary preliminary data to provide to SIU Investigators and make recommendations for next steps on a case referral. In addition, SIU Associate I will perform monthly sanctions reviews, prepare and submit required FWA-related reports, assist in initial, annual and ongoing training to staff in the prevention and detection of fraud, waste and abuse and assist in developing ongoing communications to increase fraud awareness among staff and customers. SIU Associate I will follow through on deliverables and assignments timely with limited prompting. The role requires good knowledge of pharmacy claims, billing and payment.
Is this you? Find out more below!
ResponsibilitiesHow do I make an impact on my team?
Open SIU cases upon referral, assign a tracking number and initiate triage by gathering necessary data such as call notes, 3D reports, etcAssign to SIU Investigator for further action on case referrals based on data gathered, line of business and availability of InvestigatorLead ID theft/stolen card investigations reported on membersConduct monthly reviews of the OIG/EPLS sanctions list and prepare necessary documentation of reviewsAssist the SIU team with gathering of claims data and other FWA information for the completion and submission of client contractually required and management level reports on fraud detection activities in an accurate and timely basisMaintain work instructions associate with exclusion, FWA publication monitoring, and reporting responsibilitiesAssist in the development of fraud and compliance training for all new employees, annual re-training and ongoing training for existing employees including preparation of training materials and tracking training activitiesContinuously research and identify latest fraud trends; regularly monitor media (publications, web sites, etc.) and prepare communications to keep employees aware of fraud issues and trendsActively participate in local, state and national organizations and events focused on fraud prevention and detectionOther duties as assigned QualificationsWhat our team expects from you?
Bachelor’s Degree or a combination of education and relevant work experience is requiredMust demonstrate a willingness to work towards the fraud investigator certification to qualify for increased level of responsibility and promotional opportunitiesPharmacy Technician certification strongly desiredA minimum of 1 year experience in pharmacy and/or healthcare claims investigations and/or auditing preferably with a Special Investigative Unit is highly desiredKnowledge of Medicare, Medicaid, and third-party payer billing regulations and reimbursement is also highly desiredParticipate in, adhere to, and support compliance program objectivesThe ability to consistently interact cooperatively and respectfully with other employeesWhat can you expect from Navitus? • Top of the industry benefits for Health, Dental, and Vision insurance • 20 days paid time off • 4 weeks paid parental leave • 9 paid holidays • 401K company match of up to 5% - No vesting requirement • Adoption Assistance Program • Flexible Spending Account #LI-Remote
We are unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.
Location : Address 1025 West Navitus Dr. Location : City Appleton Location : State/Province WI Location : Postal Code 54913 Location : Country US Options ApplyApplySubmit a ReferralRefer Sorry the Share function is not working properly at this moment. Please refresh the page and try again later. Application FAQsSoftware Powered by iCIMS
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