Elevance Health is a healthcare and health insurance company building a broader, long-term approach to supporting people’s health. Its work combines health benefits, integrated whole-health services, and digital health capabilities designed to connect care and coverage more effectively. With a workforce of nearly 100,000 associates serving more than 118 million people, Elevance Health offers roles across a large, multidisciplinary organization focused on improving health outcomes, evolving the healthcare system, and supporting stronger communities.
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.
Description
- 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.
Requirements
- 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.
Benefits
- 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