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

CareBridge; Mason (OH); Hybrid; USD 60,000 - 95,000; Full time

Job summary

An established industry player is seeking a detail-oriented Provider Auditor to join their team. This role combines remote and in-office work, allowing for flexibility while ensuring accurate claim payments and compliance with industry standards. The ideal candidate will leverage their medical coding expertise and analytical skills to review medical charts and contracts, ensuring the integrity of billing processes. With a focus on improving healthcare services, this position offers a dynamic environment where your contributions will have a significant impact. If you are passionate about healthcare and compliance, this opportunity is perfect for you.

Benefits

Competitive Rewards

Health Benefits

Flexible Work Environment

Career Development Opportunities

Qualifications

• 2+ years of experience in medical coding or auditing.
• Strong understanding of medical billing and coding standards.

Responsibilities

• Select and review providers based on data and contracts.
• Analyze claims and document findings for accuracy.
• Identify billing anomalies and participate in policy development.

Skills

Medical Coding

Data Analysis

Contract Review

Billing Verification

Education

BA/BS Degree

RN/LPN Certification

Medical Coding Certification

Tools

Facets Software

Job description

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

Join to apply for the Provider Auditor (RN/LPN Medical Coder or Certified Medical Coder) role at CareBridge.

This position offers a hybrid work model (remote and office), requiring presence once a week. The ideal candidate will reside within 50 miles of an Elevance Health PulsePoint location.

Carelon Payment Integrity, part of Elevance Health, focuses on recovering and preventing unnecessary medical expenses. The Provider Auditor reviews medical charts, notes, bills, and provider contracts to ensure accurate claim payments in line with contracts, policies, and industry standards.

Responsibilities include:

1. Select providers for review based on historical data, network input, and dollar volume.
2. Analyze data and conduct reviews using medical charts, notes, and contracts.
3. Verify claim amounts, document findings, and request payments for overcharges.
4. Identify billing anomalies and potential abuse.
5. Participate in policy development and departmental committees.

Minimum Requirements:

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

Preferred Skills:

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

Note: Elevance Health only accepts resumes from agencies with a signed agreement. Unsolicited resumes are the property of Elevance Health.

About Elevance Health:

A Fortune 25 healthcare company dedicated to improving lives through simplified healthcare services, offering competitive rewards, benefits, and a hybrid work environment. Candidates must reside within 50 miles of a relevant location and be vaccinated against COVID-19 and Influenza where applicable.

Equal Opportunity Employment:

We consider all qualified applicants regardless of age, citizenship, race, gender, or other protected statuses. Accommodations are available upon request.