Audit Specialist conducting risk based audits at RTX Corporation. Engaging in process improvements and presenting insights to senior management while facilitating project management and coaching staff.
About the role
- Clinical Provider Auditor II conducting claims examinations and fraud analysis at Elevance Health. Collaborating with internal teams and remaining updated on medical coding and billing regulations.
Responsibilities
- 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
- Uses required systems/tools to accurately document determinations
- Researches new healthcare related questions as necessary to aid in investigations
- Stays abreast of current medical coding and billing issues, trends, and changes in laws/regulations
- Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern
- Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation
- Assists with training of new associates
Requirements
- Requires a AA/AS and minimum of 3 years medical coding/auditing experience
- Minimum of 1 year in fraud, waste abuse experience
- Requires coding certification (CPC, CCS, CPMA)
- Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology preferred
- Bachelor's degree strongly preferred
- Experience coding for different specialties preferred
- Strong knowledge of MS Excel and Word highly preferred
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
- Merit increases
- Paid holidays
- Paid Time Off
- Medical benefits
- Dental benefits
- Vision benefits
- Short and long term disability benefits
- Life insurance
- Wellness programs
- Financial education resources
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