Senior Clinical Quality Auditor performing internal audits, analyzing results, and collaborating with clinical operations teams at DaVita. Assisting leadership with daily operations of the Clinical Quality Auditing team.
About the role
- Clinical Provider Auditor II role in Elevance Health's Payment Integrity evaluating claims for fraud prevention. Responsibilities include auditing, compliance checks, and collaborating with internal teams.
Responsibilities
- Supports the Payment Integrity line of business
- Examines claims for compliance with relevant 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
- Researches new healthcare related questions as necessary to aid in investigations
- Collaborates with the Special Investigation Unit and other internal areas
- Recommends possible interventions for loss control and risk avoidance
- Assists with training of new associates
Requirements
- Requires a AA/AS
- Minimum of 4 years medical coding/auditing experience
- Minimum of 1 year in fraud, waste abuse experience
- Must have coding certification (CPC, CCS, CPMA)
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
- Paid Time Off
- Medical insurance
- Dental insurance
- Vision insurance
- Short and long term disability benefits
- Life insurance
- Wellness programs
- Financial education resources
Job title
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