Elevance Health Clinical Provider Auditor Senior - Tampa, Florida
Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.
Position Overview:
The Clinical Provider Auditor Sr will be responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse.
How You Will Make an Impact:
- 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.
- 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 to determine patterns of billing behavior.
- Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation.
- Trains new associates.
- Develops, designs and implements new or revised methods to improve operations.
Minimum Requirements:
Requires an AA/AS and a minimum of 6 years medical coding/auditing experience, including a minimum of 4 years in fraud, waste, and abuse experience; or any combination of education and experience that would provide an equivalent background.
Requires coding certification (CPC, CCS, CPMA).
Preferred Skills, Capabilities, and Experiences:
Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology.
Company Overview:
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels who are passionate about making an impact on our members and the communities we serve.
Work Environment:
At Elevance Health, we are creating a culture that is designed to advance our strategy while leading to personal and professional growth for our associates.
Benefits:
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs, medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources.
COVID-19 Vaccination Requirement:
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19.
Equal Employment Opportunity:
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to any status or condition protected by applicable federal, state, or local laws.
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