Provider Auditor (Licensed Nurse)

Elevance Health; Mason (OH); Hybrid; USD 60,000 - 90,000; Full time

Job summary

An innovative healthcare company is seeking a detail-oriented Provider Auditor to join their team. This role, which operates in a hybrid model, involves conducting thorough reviews of medical charts and provider contracts to ensure compliance with standards and policies. As part of a dynamic team, you will analyze data, verify claims, and assist in developing procedural improvements. This position offers a unique opportunity to make a significant impact on healthcare spending while working closely with a network of providers. If you are passionate about healthcare integrity and have the required qualifications, this role could be your next career move.

Qualifications

• 2+ years of experience in medical auditing or coding.
• Strong analytical skills for data and chart review.

Responsibilities

• Conduct on-site reviews of medical charts and contracts.
• Analyze data and prepare reports on claim amounts.

Skills

Data Analysis

Medical Chart Review

Billing Verification

Policy Development

Education

BA/BS Degree

Medical Coding Certification

Tools

Facets Software

Job description

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Provider Auditor (RN/LPN Medical Coder or Certified Medical Coder)

This position will work a hybrid model (remote and office), 1 time per week. The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

Carelon Payment Integrity is a proud member of the Elevance Health family of companies. It is determined to recover, eliminate, and prevent unnecessary medical-expense spending.

The Provider Auditor conducts on-site reviews of medical charts, notes, bills, and provider contracts to ensure claims are paid according to contracts, policies, and standards.

How you will make an impact:

• Choose providers for review based on past results, network input, and dollar volume.
• Analyze data, review medical charts, notes, and contracts.
• Verify claim amounts and prepare reports, requesting payments for overcharges.
• Identify billing patterns and potential abuse.
• Assist in developing or reviewing policies and procedures.
• Participate in task forces and committees.

Qualifications:

• BA/BS degree and at least 2 years of relevant experience, or equivalent background.
• RN, LPN, or medical coding certification strongly preferred.

Preferred Skills:

• Medical coding certification.
• Knowledge of contract language and federal guidelines.
• Experience with Facets software.

Note: Resume submissions from agencies require a signed agreement; unsolicited resumes are property of Elevance Health.