Clinical Provider Auditor II
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Grand Prairie • Florida • Kentucky • United States
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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
- Collaborate with the Special Investigation Unit
- Recommend possible interventions for loss control and risk avoidance
- Assist with training of new associates
Requirements
- Requires AA/AS and minimum of 3 years medical coding/auditing experience, including minimum of 1 year in fraud, waste abuse experience
- Requires coding certification (CPC, CCS, CPMA)
- Preferred Skills: E/M leveling experience
- Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology
- Bachelor's degree is preferred
Benefits
- Health insurance
- 401(k) + match
- Paid time off
- Paid holidays
- incentive bonus programs
- short and long term disability benefits
- 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 preventionICD-10 codingCPT codingHCPCS codingE/M levelingbilling complianceclaims analysisrisk avoidance
Soft Skills
collaborationtrainingcommunicationanalytical thinkingproblem-solving
Certifications
CPCCCSCPMA