Quality Auditor, Hospital Bill Audits, Itemized Bill Review

Elevance Health

Quality Auditor at Elevance Health overseeing hospital bill audits and reviews for accuracy and standards compliance while enhancing audit workflows. Collaborating with teams to identify improvements and support audits.

Posted 6/10/2026full-timeIndianapolis • Florida, Kansas, Kentucky • 🇺🇸 United StatesSeniorLeadWebsite

About the role

Key responsibilities & impact

Perform retrospective quality audits (QA) of audit cases
Validate that findings are supported, accurately documented, and consistent with audit rationale
Ensure audit determinations appropriately apply payer policies, coding/billing guidelines, and reimbursement rules
Confirm the audit file contains complete evidence to support recoveries/avoidance and to withstand provider appeals
Apply established QA methodology to evaluate performance consistently
Identify and classify errors
Maintain quality dashboards and trending reports
Participate in calibration sessions with reviewers
Provide structured feedback to audit teams
Support business reviews by summarizing quality findings, root causes, and improvement opportunities
Recommend updates to job aids, templates, and audit checklists to reduce variation and improve defensibility
Escalate high-risk issues to leadership

Requirements

What you’ll need

Requires a BA/BS degree in a related field
a minimum of 7 years reimbursement experience
performing detailed financial modeling and economic analyses
Registered Nurse (RN) license strongly preferred
Certifications (any relevant): CCS, CPC preferred
Clinical experience (e.g., acute care, med-surg, ICU, ED, OR, case management, utilization review) preferred
Strong ability to interpret medical records and connect documentation to billed services and audit determinations preferred
Working knowledge of hospital billing concepts (UB-04, revenue codes, itemized bills) and how clinical documentation supports charges and units preferred
Knowledge of common payment policies and guidelines (CMS-based rules as applicable, MCO policies, and/or commercial payer policies) preferred
Familiarity with hospital coding/reimbursement concepts (DRG/APC, chargemaster, NCCI, OPPS/IPPS principles) preferred
Experience with audit platforms/claims systems (payer or vendor tools) preferred

Benefits

Comp & perks

merit increases
paid holidays
Paid Time Off
incentive bonus programs
medical benefits
dental benefits
vision benefits
short and long term disability benefits
401(k) + match
stock purchase plan
life insurance
wellness programs
financial education resources

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

quality auditsfinancial modelingeconomic analyseserror classificationmedical record interpretationhospital billing conceptspayment policiescoding/reimbursement conceptsaudit platformsclaims systems

Soft Skills

structured feedbackcommunicationproblem-solvingcollaborationattention to detailanalytical thinkingorganizational skillsleadershipcalibration participationreporting

Certifications

BA/BS degreeRegistered Nurse (RN)CCSCPC