„Elevance Health“ yra sveikatos priežiūros ir sveikatos draudimo bendrovė, kurianti platesnį ir ilgalaikį požiūrį į žmonių sveikatos palaikymą. Jos veikla apima sveikatos išmokas, integruotas visapusiškos sveikatos paslaugas ir skaitmeninės sveikatos sprendimus, skirtus veiksmingiau susieti priežiūrą ir draudimo apsaugą. Beveik 100 000 darbuotojų turinti ir daugiau nei 118 milijonų žmonių aptarnaujanti „Elevance Health“ siūlo galimybes didelėje, įvairių sričių organizacijoje, kurios tikslas – gerinti sveikatos rezultatus, tobulinti sveikatos priežiūros sistemą ir stiprinti bendruomenes.
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.
Aprašymas
- 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.
Reikalavimai
- 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.
Privalumai
- 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