Clinical Provider Auditor I
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Miami • Florida • United States
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Job Level
About the role
- Identifying issues and/or entities that may pose potential risk associated with fraud and abuse
- Examines claims for compliance with relevant billing and processing guidelines
- Reviews and conducts analysis of claims and medical records prior to payment
- Researches new healthcare related questions as necessary to aid in investigations
- Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern
- Recommends possible interventions for loss control and risk avoidance
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
- Health insurance
- 401(k) + match
- Paid Time Off
- Incentive bonus programs
- Paid holidays
- Short and long term disability benefits
- Stock purchase plan
- 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 codingauditingICD-10CPT codingHCPC codingclaims analysisbilling compliancerisk assessmentfraud detectionloss control
Soft Skills
collaborationcommunicationanalytical thinkingproblem-solvingattention to detail
Certifications
CPCCCSCPMA