Senior Provider Auditor: Payment Integrity & Clinical Audit

The Elevance Health Companies, Inc.; Atlanta (GA); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Medical benefits

401(k) + match

Stock purchase plan

Life insurance

Wellness programs

Job summary

Elevance Health is seeking a Provider Auditor Senior – Payment Integrity Complex and Clinical Audit to conduct on-site reviews of medical charts, notes, and contracts to ensure correct claim payments. This role supports a hybrid work model requiring in-office presence 1–2 days per week with some locations offering alternate arrangements.

You will select providers for review, analyze data, prepare findings reports, and mentor junior staff while collaborating with care management and finance

Qualifications

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

Responsibilities

• Selects providers for review based on historical results and dollar volume.
• Analyzes data and conducts on-site reviews using charts, notes, itemized bills, and contracts.
• Verifies payments and drafts findings reports; identifies abnormal billing patterns.
• Mentors and trains staff; drafts policies and procedures.

Skills

Healthcare auditing

Data analysis

Communication skills

Education

BA/BS degree

RN certification

Medical coding certification

Tools

Home Infusion billing systems

DME/Dialysis billing knowledge

Job description

Elevance Health is seeking a Provider Auditor Senior – Payment Integrity Complex and Clinical Audit to conduct on-site reviews of medical charts, notes, and contracts to ensure correct claim payments. This role supports a hybrid work model requiring in-office presence 1–2 days per week with some locations offering alternate arrangements.

You will select providers for review, analyze data, prepare findings reports, and mentor junior staff while collaborating with care management and finance