Hybrid Clinical Provider Auditor II

Posted 6 days ago

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About the role

  • 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

Clinical Provider Auditor II

Job type

Experience level

Mid levelSenior

Salary

$61,320 - $100,740 per year

Degree requirement

Associate's Degree

Location requirements

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