Hybrid Clinical Provider Auditor I

Posted 2 hours ago

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About the role

  • Clinical Provider Auditor I role at Elevance Health focusing on fraud and abuse prevention in claims. Responsibilities include compliance examination and collaboration with internal teams.

Responsibilities

  • Identifying issues and/or entities that may pose potential risk associated with fraud and abuse
  • Examines claims for compliance with billing and processing guidelines
  • Conducts analysis of claims and medical records prior to payment
  • Collaborates with the Special Investigation Unit and other internal areas
  • Recommends possible interventions for loss control and risk avoidance

Requirements

  • AA/AS and minimum of 1 year related medical coding/auditing experience
  • Coding certification (CPC, CCS, CPMA) within one year of starting
  • Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology strongly preferred

Benefits

  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase
  • 401k contribution
  • Paid time off
  • Medical, dental, and vision benefits
  • Short and long-term disability benefits
  • Life insurance
  • Wellness programs
  • Financial education resources

Job title

Clinical Provider Auditor I

Job type

Experience level

Junior

Salary

$25 - $48 per hour

Degree requirement

Associate's Degree

Location requirements

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