Special Investigation Unit Coding Director (Aetna SIU)

Are you a highly skilled and experienced coding professional looking for a challenging and rewarding role? Aetna is seeking a dynamic individual to join our team as the Special Investigation Unit Coding Director for our Aetna SIU division. In this role, you will have the opportunity to lead a team of coding specialists in the detection and prevention of healthcare fraud and abuse. We are looking for someone with a passion for coding and a strong background in healthcare fraud detection to help us protect the integrity of our healthcare system. If you are a driven and detail-oriented individual with excellent leadership skills, we want to hear from you!

Lead a team of coding specialists in the detection and prevention of healthcare fraud and abuse.
Develop and implement strategies to identify and investigate potential fraudulent activities.
Conduct regular audits and reviews of coding processes and procedures to ensure compliance with industry standards.
Collaborate with cross-functional teams to develop and implement fraud prevention measures.
Analyze coding data and trends to identify potential areas of fraud and abuse.
Provide guidance and training to team members on coding best practices and fraud detection techniques.
Stay updated on industry regulations and changes in coding practices to ensure compliance.
Work closely with law enforcement agencies and legal teams to support investigations and potential legal actions.
Develop and maintain relationships with external partners and organizations to enhance fraud detection efforts.
Prepare and present reports and findings to senior management and stakeholders.
Monitor and evaluate team performance and provide coaching and feedback as needed.
Identify and implement process improvements to enhance the efficiency and effectiveness of fraud detection efforts.
Participate in departmental and company-wide meetings and initiatives related to fraud detection and prevention.
Maintain confidentiality and adhere to company policies and procedures.
Act as a subject matter expert on coding and healthcare fraud for the organization.

Aetna is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.