Remote Clinical Provider Auditor I

Elevance Health (Anthem); Mason (OH); Hybrid; USD 55,000 - 70,000; Full time

Benefits offered by this job

Merit increases

Paid holidays

Paid Time Off

Medical

Dental

Vision

Disability insurance

401(k) +match

Stock purchase plan

Life insurance

Wellness programs

Job summary

Elevance Health seeks a Clinical Provider Auditor I to identify fraud and abuse risks in claims and medical records. The role emphasizes thorough documentation and collaboration with the Special Investigation Unit in a hybrid work model.

Responsibilities include examining claims for billing compliance, researching coding issues, and recommending interventions to control losses. A minimum AA/AS and 1 year of related experience are required, with certification within the first year.

Qualifications

• AA/AS and minimum 1 year related medical coding/auditing experience required.
• Must achieve coding certification (CPC, CCS, CPMA) within 1 year of starting.
• Knowledge of ICD-10 and CPT/HCPCS preferred.

Responsibilities

• Examines claims for compliance with billing guidelines and identifies fraud risk.
• Reviews claims and medical records prior to payment and documents determinations.
• Researches healthcare questions to aid investigations and stays updated on coding issues.
• Collaborates with Special Investigation Unit and other internal areas.
• Recommends interventions for loss control based on investigations.

Skills

Medical coding

Auditing

Documentation

Attention to detail

Education

AA/AS degree

Job description

Elevance Health seeks a Clinical Provider Auditor I to identify fraud and abuse risks in claims and medical records. The role emphasizes thorough documentation and collaboration with the Special Investigation Unit in a hybrid work model.

Responsibilities include examining claims for billing compliance, researching coding issues, and recommending interventions to control losses. A minimum AA/AS and 1 year of related experience are required, with certification within the first year.