Clinical Provider Auditor I
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. The Clinical Provider Auditor I is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse, examining claims for compliance, and collaborating with the Special Investigation Unit.
Responsibilities
- Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control
- Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to accurately document determinations and continue to next step in the claims lifecycle
- Researches new healthcare related questions as necessary to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in laws/regulations
- Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern
- Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation
Skills
- Requires a AA/AS and minimum of 1 year related medical coding/auditing experience; or any combination of education and experience, which would provide an equivalent background
- Must achieve coding certification (CPC, CCS, CPMA) within one year of starting in this position
- Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology strongly preferred
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical
- Dental
- Vision
- Short and long term disability benefits
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
Company Overview
Company H1B Sponsorship