Senior Provider Auditor — Payment Integrity

Elevance Health; Atlanta (GA); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Elevance Health is hiring a Provider Auditor Senior to lead on-site reviews of medical charts, notes, itemized bills, and provider contracts to ensure claims are paid per contract and policy. The role involves selecting providers for review, scheduling, analyzing data, and presenting findings to management.

The Senior Auditor will verify dollar amounts in the claims system, document findings, and pursue overpayments.

Qualifications

• Requires a BA/BS degree and a minimum of 3 years equivalent work experience.
• RN and medical coding certification strongly preferred.
• Experience with billing/auditing for Home Infusion, DME and/or Dialysis preferred.

Responsibilities

• Conducts on-site reviews of medical charts, notes, itemized bills and provider contracts to ensure payment aligns with contract and policies.
• Selects providers for review based on historical results and dollar volume; schedules and conducts reviews.
• Performs exit interview with provider management and presents preliminary results.
• Verifies claim amounts in the claims system and drafts findings reports; initiates overpayment recovery as needed.
• Identifies anomalous billing patterns and potential abuse; mentors junior staff.
• Drafts department policies and educational materials; participates in task forces and committees.

Skills

Provider auditing

Medical coding (certified)

RN certification preferred

Billing/auditing experience

Education

BA/BS degree

Tools

None

Job description

Elevance Health is hiring a Provider Auditor Senior to lead on-site reviews of medical charts, notes, itemized bills, and provider contracts to ensure claims are paid per contract and policy. The role involves selecting providers for review, scheduling, analyzing data, and presenting findings to management.

The Senior Auditor will verify dollar amounts in the claims system, document findings, and pursue overpayments.