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

CareBridge; Tampa (FL); Hybrid; USD 55,000 - 75,000; Full time

Job summary

A leading healthcare company is seeking a Provider Auditor to conduct reviews of medical charts and claims. This entry-level position requires analytical skills and a BA/BS degree, with a preference for candidates holding medical coding certifications. The role offers a hybrid work model and competitive benefits.

Benefits

Bonuses

Paid time off

Health benefits

401(k) matching

Stock plans

Wellness programs

Qualifications

• BA/BS degree with at least 2 years' relevant experience.
• RN, LPN, or medical coding certification preferred.
• Medical coding certification highly preferred.

Responsibilities

• Conduct on-site reviews of medical charts and claims.
• Analyze data and verify claim amounts.
• Detect billing anomalies and assist in policy development.

Skills

Analytical skills

Attention to detail

Knowledge of contract language

Education

BA/BS degree

RN, LPN, or 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), with onsite presence once per week. The ideal candidate will reside within 50 miles of an Elevance Health PulsePoint location.

Carelon Payment Integrity, part of the Elevance Health family, focuses on recovering, eliminating, and preventing unnecessary medical expenses.

Role Overview

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 industry standards.

Key Responsibilities

1. Choose providers for review based on past results, network input, and claim volume.
2. Analyze data, review claims using medical records, notes, and contracts.
3. Verify claim amounts, document findings, and request payments for overcharges.
4. Detect billing anomalies and potential abuse.
5. Assist in developing or reviewing policies and procedures.
6. Participate in task forces and committees.

Minimum Requirements

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

Preferred Skills & Experience

• 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 Us

Elevance Health is dedicated to improving lives and communities, with a Fortune 25 ranking. We value creating a culture that promotes growth, aligned with our core values and behaviors.

Benefits & Work Environment

We offer competitive rewards, including bonuses, paid time off, health benefits, 401(k) matching, stock plans, and wellness programs. Our hybrid work strategy requires associates to work onsite at least once a week, within 50 miles of a designated location.

All new candidates in certain roles must be vaccinated against COVID-19 and Influenza unless an exemption is provided. We are an Equal Opportunity Employer, committed to diversity and inclusion.

Additional Details

• Seniority level: Entry level
• Employment type: Full-time
• Job function: Accounting/Auditing and Finance
• Industries: Accounting