Quality Auditor responsible for quality process and metrology in an inclusive healthcare environment. Collaborating with teams to maintain standards and documentation for production in Williamsport, PA.
About the role
- Clinical Provider Auditor II responsible for examining claims and identifying fraud risks at Elevance Health. Collaborating with internal teams and assisting in training new associates.
Responsibilities
- Examines claims for compliance with billing and processing guidelines
- Identifies opportunities for fraud and abuse prevention and control
- Reviews and conducts analysis of claims and medical records prior to payment
- Uses required systems/tools to accurately document determinations
- Researches new healthcare related questions as necessary
- Collaborates with the Special Investigation Unit and other internal areas
- Recommends possible interventions for loss control
- Assists with training of new associates
Requirements
- Requires a AA/AS
- Minimum of 3 years medical coding/auditing experience
- Minimum of 1 year in fraud, waste abuse experience
- Coding certification (CPC, CCS, CPMA)
- Strong knowledge of MS Excel and Word
- Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
- Paid Time Off
- Paid holidays
- Medical benefits
- Dental benefits
- Vision benefits
- Short and long term disability benefits
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