Clinical Provider Auditor II
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Norfolk • Florida • Kentucky • United States
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About the role
- Examines claims for compliance with relevant billing and processing guidelines
- Identifies opportunities for fraud and abuse prevention and control
- Reviews and conducts analysis of claims and medical records prior to payment
- Uses required systems/tools to accurately document determinations
- Researches new healthcare related questions as necessary to aid in investigations
- 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
- Assists with training of new associates
Requirements
- Requires AA/AS and minimum of 3 years medical coding/auditing experience
- Minimum of 1 year in fraud, waste abuse experience
- Requires coding certification (CPC, CCS, CPMA)
- E/M leveling experience preferred
- Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology preferred
- Bachelor's degree preferred
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- 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 & Tools
medical codingauditingfraud preventionbilling complianceICD-10 codingCPT codingHCPCS codingE/M levelingclaims analysisrisk avoidance
Soft Skills
collaborationtrainingcommunicationanalytical thinkingproblem-solving
Certifications
CPCCCSCPMA