Provider Audit Specialist

Capital Blue Cross

Provider Audit Specialist responsible for auditing hospital charge data and claims. Collaborating with internal teams to ensure billing compliance and recommend improvements.

Posted 5/23/2026full-timeRemote • Pennsylvania • 🇺🇸 United StatesJuniorMid-Level💰 $55,100 - $103,810 per yearWebsite

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Conduct end-to-end audits of provider charge masters (CDM) and associated claims to evaluate billing accuracy, rate structures, and adherence to contractual and regulatory requirements.
Review and analyze provider chargemaster data to identify outliers, inconsistencies, or policy violations.
Assist in the development and maintenance of audit models, dashboards, and templates to support enterprise audit functions.
Prepare audit summaries with findings and recommendations.
Support provider communications regarding audit findings and recommend process improvements.
Maintain current knowledge of CMS guidelines, payer policies, and healthcare billing standards (UB-04, CPT, HCPCS, revenue codes).
Contribute to reimbursement and contract review projects.

Requirements

What you’ll need

2-4 years in provider auditing, revenue integrity, hospital billing, or charge master analysis
Proficiency in Microsoft Office Suite products (Access, Excel, Word, PowerPoint, etc.), SAS, SQL, PowerBI, or other software used for both analytic, reporting, and data visualization functions.
Knowledge of CPT/HCPCS coding, CMS billing guidelines, and provider reimbursement methodologies.
Bachelor’s degree in healthcare administration, Health Information Management, Accounting, or related field.
Preferred certifications: Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA).

Benefits

Comp & perks

Professional development opportunities
Flexible working arrangements

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

provider auditingrevenue integrityhospital billingcharge master analysisCPT codingHCPCS codingCMS billing guidelinesdata analysisdata visualizationaudit models

Soft Skills

communicationanalytical thinkingattention to detailproblem-solvingrecommendation development

Certifications

Certified Professional Coder (CPC)Certified Professional Medical Auditor (CPMA)