Remote Clinical Claims Auditor I

The Elevance Health Companies, Inc.; Mason (OH); Hybrid; USD 55,000 - 75,000; Full time

Job summary

Elevance Health in Mason, Ohio is seeking a Clinical Provider Auditor I to review claims for compliance and identify fraud opportunities. This role supports virtual full-time work with required in-person training and occasional location visits within commuting distance.

You will analyze medical records and coding, collaborate with the SIU, and stay current with ICD-10 and CPT/HCPC guidelines. AA/AS and 1 year auditing experience required; certification within 12 months expected.

Qualifications

• AA/AS and minimum of 1 year related medical coding/auditing experience.
• Must achieve coding certification (CPC, CCS, CPMA) within one year of starting in this position.
• Knowledge of ICD-10 and CPT/HCPC coding guidelines strongly preferred.

Responsibilities

• Examine claims for compliance with billing and processing guidelines.
• Review and analyze claims and medical records prior to payment.
• Collaborate with the Special Investigation Unit on investigations.
• Recommend loss-control interventions based on investigation outcomes.

Skills

Medical coding

Auditing

Fraud detection

Education

AA/AS degree

Job description

Elevance Health in Mason, Ohio is seeking a Clinical Provider Auditor I to review claims for compliance and identify fraud opportunities. This role supports virtual full-time work with required in-person training and occasional location visits within commuting distance.

You will analyze medical records and coding, collaborate with the SIU, and stay current with ICD-10 and CPT/HCPC guidelines. AA/AS and 1 year auditing experience required; certification within 12 months expected.