Clinical Provider Auditor II

🔥 37 minutes ago

🐊 Florida, North Carolina, +2 more states – Remote

🐊 Florida – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🤠 Texas – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Elevance Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Elevance Health is transforming from a traditional health benefits organization into a lifetime trusted health partner, driven by a bold purpose to improve the health of humanity. With nearly 100,000 associates, they serve over 118 million people and utilize an integrated whole health approach supported by industry-leading capabilities and a digital health platform. Their mission includes redefining health, reimagining the health system, and strengthening communities.

📋 Description

• Identify issues and/or entities that may pose potential risk associated with fraud and abuse • Examine claims for compliance with relevant billing and processing guidelines • Identify opportunities for fraud and abuse prevention and control • Review and analyze claims and medical records prior to payment • Use required systems/tools to accurately document determinations and continue to the next step in the claims lifecycle • Research healthcare-related questions to aid investigations • Stay current on medical coding and billing issues, trends, and legal/regulatory changes • Collaborate with the Special Investigation Unit and other internal areas • Recommend interventions for loss control and risk avoidance based on investigation outcomes • Assist with training new associates

🎯 Requirements

• AA/AS and minimum of 3 years medical coding/auditing experience, including minimum of 1 year in fraud, waste abuse experience; or any combination of education and experience providing an equivalent background • Coding certification (CPC, CCS, CPMA) • Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology • Candidates must reside within a reasonable commuting distance from a posting location unless an accommodation is granted as required by law • Candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless an acceptable explanation is provided • Bachelor's degree strongly preferred

🏖️ Benefits

• Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical benefits • Dental benefits • Vision benefits • Short-term disability benefits • Long-term disability benefits • 401(k) match • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Virtual full-time work, except for required in-person training sessions