Remote Medical Claims Auditor I

Elevance Health; United States; A distancia; USD 52.000 - 68.000; Jornada completa

Descripción de la vacante

Elevance Health is seeking a claims examiner/auditor to review claims for compliance and analyze medical records prior to payment, supporting fraud prevention. This role offers virtual full-time work with required in-person training sessions and flexibility within commuting distance.

Candidates should have an AA/AS and at least 1 year of medical coding/auditing experience, with certification within a year. ICD-10/CPT/HCPC knowledge is preferred; behavioral health experience is a plus.

Formación

• Requires an AA/AS and minimum of 1 year related medical coding/auditing experience; or any combination of education and experience, which would provide an equivalent background.
• Must achieve coding certification (CPC, CCS, CPMA) within one year of starting in this position.
• Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology strongly preferred.
• Experience in Behavioral Health preferred

Responsabilidades

• Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control.
• Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to accurately document determinations and continue to next step in the claims lifecycle.
• Researches new healthcare related questions as necessary to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in laws/regulations.
• Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern.
• Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation.

Conocimientos

Medical coding/auditing

Educación

AA/AS degree

Descripción del empleo

Elevance Health is seeking a claims examiner/auditor to review claims for compliance and analyze medical records prior to payment, supporting fraud prevention. This role offers virtual full-time work with required in-person training sessions and flexibility within commuting distance.

Candidates should have an AA/AS and at least 1 year of medical coding/auditing experience, with certification within a year. ICD-10/CPT/HCPC knowledge is preferred; behavioral health experience is a plus.