Provider Audit Specialist

🔥 0 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $55.1k - $103.8k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

💻 IT Support

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Capital Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1938

⚕️ Healthcare Insurance

💸 Finance

👥 B2C

Healthcare Insurance • Finance • B2C

Capital Blue Cross is a health insurance company that offers a range of health plans for individuals, families, and employers. They serve customers in Central Pennsylvania and the Lehigh Valley, focusing on providing health coverage services such as Medicare plans, student health plans, and resources for managing medical care. Capital Blue Cross positions itself as a partner in health, emphasizing support for members' overall wellness and preventive health measures.

📋 Description

• Conduct end-to-end audits of provider charge masters (CDM) and associated claims to evaluate billing accuracy • Review and analyze provider chargemaster data to identify outliers, inconsistencies, or policy violations • Assist in the development and maintenance of audit models, dashboards, and templates • Prepare audit summaries with findings and recommendations • Support provider communications regarding audit findings and recommend process improvements • Maintain current knowledge of CMS guidelines, payer policies, and healthcare billing standards

🎯 Requirements

• 2-4 years in provider auditing, revenue integrity, hospital billing, or charge master analysis • Proficiency in Microsoft Office Suite products (Access, Excel, Word, PowerPoint, etc.), SAS, SQL, PowerBI • Knowledge of CPT/HCPCS coding, CMS billing guidelines, and provider reimbursement methodologies • Bachelor’s degree in healthcare administration, Health Information Management, Accounting, or related field • Preferred certifications: Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA)

🏖️ Benefits

• flexible environment prioritizing health and wellbeing • investment in training and continuing education