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Position Summary
 

The SIU Coordinator provides operational, administrative, and analytical support to the Special Investigations Unit (SIU) across the Generations Advantage and US Family Health Plan lines of business. The Coordinator is the SIU’s intake hub. The role manages referral intake and preliminary claims research, medical records requests, standard written correspondence, deadline tracking, case management system administration, and metrics reporting. It reports to the Director, SIU, and serves as an entry point into an investigative career path.

Job Description

PRIMARY DUTIES AND RESPONSIBILITIES

• Manages SIU intake. Receives, logs, and acknowledges referrals from the hotline, internal departments, members, providers, and external agencies. Does preliminary research to support triage, including eligibility, claims history, and provider enrollment.
• Coordinates medical records requests. Tracks due dates, follows up on outstanding requests, and maintains records intake and documentation logs.
• Prepares and issues standard SIU correspondence from the SIU department template library under the Director’s or Investigator’s direction. Examples include records requests, payment hold notifications, prepayment review notices, and acknowledgements.
• Maintains the SIU case management system and SharePoint site, keeps the data accurate, and runs routine reports.
• Compiles monthly and quarterly SIU metrics for leadership, the Compliance Committee, and regulatory reporting.
• Tracks regulatory and contractual deadlines, including referral timeframes and responses to CMS and DHA requests for information.
• Helps investigators with claims data pulls, spreadsheet analysis, and exhibit preparation. May investigate low-complexity cases under supervision.

Employees are expected to work consistently to demonstrate the mission, vision, and core values of the organization.

POSITION QUALIFICATIONS

Education:

• Associate’s degree or an equivalent combination of education and experience required.
• Bachelor’s degree preferred.

Experience:

• Two or more years in health plan SIU operations, claims, compliance, or payment integrity required.
• Experience with case management systems and SharePoint preferred.

Knowledge:

• Knowledge of medical terminology and claims processing preferred.

Skills:

• Intermediate to advanced Excel skills.
• Clear, professional written communication.
• Discretion with PHI and sensitive investigative information.
• Interest in developing investigative skills

 

Abilities:

• Demonstrates an understanding of and alignment with Martin’s Points values.
• Highly organized, detail oriented, and disciplined about deadlines.

Pay Range: $65,725.40 - $81,190.20 To promote pay equity, Martin’s Point Healthcare has established defined salary ranges for each role. Compensation is established within the posted range based on a variety of factors, including relevant years of experience, current market conditions, internal equity, and budget considerations. The pay range reflects the potential compensation for this role based on a full-time position. Employees may also be eligible for additional compensation, such as incentive or commission-based programs, where applicable and subject to the terms of the applicable plan. Final compensation is determined at the conclusion of the interview process. We encourage you to apply even if your desired compensation falls outside of the listed range. In addition to base compensation, we offer a comprehensive benefits package including medical, dental, vision, retirement savings with employer contributions, paid time off (including volunteer time off!), pie day, and other employee benefits.

This position is not eligible for immigration sponsorship.

We are an equal opportunity/affirmative action employer.

Martin's Point complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact jobinquiries@martinspoint.org

Do you have a question about careers at Martin’s Point Health Care? Contact us at: jobinquiries@martinspoint.org