Elevance Health एक स्वास्थ्य सेवा और स्वास्थ्य बीमा कंपनी है, जो लोगों के स्वास्थ्य को सहयोग देने के लिए व्यापक और दीर्घकालिक दृष्टिकोण विकसित कर रही है। इसका काम स्वास्थ्य लाभों, समेकित समग्र-स्वास्थ्य सेवाओं और डिजिटल स्वास्थ्य क्षमताओं को जोड़ता है, ताकि देखभाल और कवरेज को अधिक प्रभावी ढंग से एक-दूसरे से जोड़ा जा सके। लगभग 100,000 कर्मचारियों के साथ 11.8 करोड़ से अधिक लोगों की सेवा करते हुए, Elevance Health एक बड़े, बहुविषयक संगठन में अवसर प्रदान करती है, जिसका उद्देश्य स्वास्थ्य परिणामों में सुधार करना, स्वास्थ्य सेवा प्रणाली को विकसित करना और अधिक सशक्त समुदायों का समर्थन करना है।
Clinical Provider Auditor I
Review healthcare claims and medical records for potential fraud and abuse, support investigations, and recommend ways to improve coding compliance and limit losses at Elevance Health.
विवरण
- Flag claims, providers, or other entities that may present fraud or abuse risks.
- Check claims against applicable billing and processing guidelines.
- Identify ways to prevent and control fraud and abuse.
- Review claims and medical records before payment.
- Record findings in required systems and tools, then advance cases through the claims process.
- Research emerging healthcare questions to support investigations.
- Track changes and trends in medical coding, billing, laws, and regulations.
- Work with the Special Investigation Unit and other internal teams.
- Recommend loss-control and risk-reduction measures based on investigation findings.
आवश्यकताएँ
- Associate of Arts or Associate of Science degree required.
- At least one year of related medical coding or auditing experience.
- Equivalent combinations of education and experience may be accepted.
- Earn a coding certification (CPC, CCS, or CPMA) within one year of starting.
- Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology is strongly preferred.
- Live within reasonable commuting distance of the listed work location unless a legally required accommodation applies.
- COVID-19 and influenza vaccination may be required for certain patient- or member-facing roles.
लाभ
- Merit increases
- Paid holidays
- Paid time off
- Incentive bonus programs
- Medical coverage
- Dental coverage
- Vision coverage
- Short-term disability coverage
- Long-term disability coverage
- 401(k) with employer match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Full-time virtual work except for required in-person training sessions
- Flexible work-life integration
- Vaccination support or coverage requirements for certain roles