Clinical Provider Auditor II – Behavioral Health

Elevance Health

Clinical Provider Auditor II handling healthcare claims compliance by examining claims and analyzing medical records. Collaborating with internal teams to prevent fraud and abuse in Behavioral Health claims.

Posted 6/19/2026full-timeHanover • Maryland • 🇺🇸 United StatesMid-LevelSenior💰 $61,320 - $76,650 per yearWebsite

About the role

Key responsibilities & impact

Supports Payment Integrity & Behavioral Health.
Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control.
Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to accurately document determinations.
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 based on the outcome of the investigation.
Assists with training of new associates.

Requirements

What you’ll need

Requires a AA/AS and minimum of 3 years medical coding/auditing experience, including minimum of 1 year in fraud, waste abuse experience; or any combination of education and experience, which would provide an equivalent background.
Requires coding certification (CPC, CCS, CPMA).
Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology.
Bachelor's degree strongly preferred.
Behavioral Health coding and auditing experience preferred.

Benefits

Comp & perks

comprehensive benefits package
incentive and recognition programs
equity stock purchase
401k contribution
merit increases
paid holidays
Paid Time Off
short and long term disability benefits
life insurance
wellness programs
financial education resources

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

medical codingauditingfraud preventionICD-10 codingCPT codingHCPC codingclaims analysisbilling compliancerisk avoidanceloss control

Soft Skills

collaborationtrainingcommunicationanalytical thinkingproblem-solving

Certifications

CPCCCSCPMA