Quality Auditor ensuring in - process and finished goods conform to specifications. Performing inspections, testing, and maintaining documentation for compliance and traceability.
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
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