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

CareBridge; Richmond (VA); On-site; USD 60,000 - 90,000; Full time

Job summary

An established industry player is seeking a Provider Auditor to join their team in a hybrid role. This position involves conducting thorough reviews of medical charts and provider contracts to ensure compliance with reimbursement policies. The ideal candidate will possess a Bachelor's degree and relevant experience, with a strong preference for those holding medical coding certifications. This role offers the opportunity to make a significant impact by identifying billing anomalies and contributing to policy development. Join a dynamic team dedicated to improving healthcare integrity and efficiency.

Qualifications

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

Responsibilities

• Conduct on-site reviews of medical charts and provider contracts.
• Analyze data to select claims for review and verify claim amounts.

Skills

Analytical Skills

Attention to Detail

Data Analysis

Education

Bachelor's Degree

Medical Coding Certification

Tools

Facets Software

Job description

Provider Auditor

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, a proud member of the Elevance Health family of companies, formerly known as Payment Integrity, is dedicated to recovering, eliminating, and preventing unnecessary medical-expense spending.

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

How you will make an impact

• Selects providers for review based on historical results, network management input, and dollar volume.
• Analyzes data to select claims for review, utilizing medical charts, notes, and provider contracts.
• Verifies claim dollar amounts and prepares reports on findings, requesting payments for overpayments.
• Identifies billing anomalies and potential abuse.
• Contributes to the development and review of department policies and procedures.
• Participates in task forces and committees.

Minimum Requirements

• Requires a BA/BS degree and at least 2 years of relevant experience, or an equivalent combination of education and experience. RN, LPN, or medical coding certification is strongly preferred.

Preferred Skills, Capabilities, and Experiences

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

Please note that Elevance Health only accepts resumes from agencies with a signed agreement. Unsolicited resumes submitted directly are considered the property of Elevance Health.