Elevance Health insonlar salomatligini qo‘llab-quvvatlashga kengroq va uzoq muddatli yondashuvni shakllantirayotgan sog‘liqni saqlash va tibbiy sug‘urta kompaniyasidir. Uning faoliyati tibbiy sug‘urta imtiyozlari, salomatlikka yaxlit yondashuvni ta’minlaydigan integratsiyalashgan xizmatlar hamda tibbiy yordam va sug‘urta qamrovini yanada samarali bog‘lash uchun yaratilgan raqamli sog‘liqni saqlash imkoniyatlarini birlashtiradi. Qariyb 100 000 nafar xodimi 118 milliondan ortiq kishiga xizmat ko‘rsatayotgan Elevance Health sog‘liq natijalarini yaxshilash, sog‘liqni saqlash tizimini rivojlantirish va yanada kuchli hamjamiyatlarni qo‘llab-quvvatlashga e’tibor qaratadigan katta, ko‘p yo‘nalishli tashkilotda turli lavozimlarni taklif etadi.
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.
Tavsif
- 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.
Talablar
- 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.
Imtiyozlar
- 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