Clinical Provider Auditor I, CPC
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Norfolk • Ohio, Tennessee, Virginia • 🇺🇸 United States
Visit company websiteJob Level
Junior
About the role
- Examine claims for compliance with relevant billing and processing guidelines
- Identify opportunities for fraud and abuse prevention and control
- Review and conduct analysis of claims and medical records prior to payment
- Use required systems/tools to accurately document determinations
- Research new healthcare related questions as necessary for investigations
- Stay abreast of current medical coding and billing issues, trends and changes in laws/regulations
- Collaborate with the Special Investigation Unit and other internal areas on matters of mutual concern
- Recommend possible interventions for loss control and risk avoidance based on outcomes
Requirements
- Requires a AA/AS and minimum of 1 year related medical coding/auditing experience
- 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
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical, dental, vision benefits
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
medical codingauditingICD-10CPT codingHCPCS codingclaims analysisbilling compliancefraud preventionrisk avoidanceloss control
Soft skills
collaborationcommunicationanalytical thinkingproblem-solvingattention to detail
Certifications
CPCCCSCPMA