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

Elevance Health; Waukesha (WI); Hybrid; USD 60,000 - 90,000; Full time

Job summary

An established industry player is seeking a detail-oriented Provider Auditor to join their team. This hybrid role involves conducting thorough reviews of medical charts, claims, and provider contracts to ensure compliance with industry standards. The ideal candidate will leverage their expertise in medical coding and data analysis to identify billing anomalies and contribute to policy development. If you are passionate about making an impact in healthcare and have the required qualifications, this is an exciting opportunity to join a forward-thinking organization committed to improving payment integrity.

Qualifications

• 2+ years of relevant experience in medical coding or auditing.
• Strong understanding of contract language and federal guidelines.

Responsibilities

• Conduct on-site reviews of medical charts and claims.
• Analyze data and verify claim amounts for accuracy.

Skills

Medical Coding

Data Analysis

Contract Review

Attention to Detail

Education

BA/BS Degree

RN/LPN 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 Elevance Health.

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, is dedicated to 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.

How You Will Make an Impact

• Select providers for review based on past results, network management input, and dollar volume.
• Analyze data, review claims using medical charts, notes, and contracts.
• Verify claim amounts, document findings, and request payments for overcharges.
• Identify billing anomalies and potential abuse.
• Participate in policy development and department initiatives.

Minimum Requirements

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

Preferred Skills and Experience

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

Elevance Health is committed to diversity and equal opportunity. We require vaccination for certain roles and follow applicable laws.