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.
Nurse Auditor
Review healthcare claims for potential fraud and overutilization at Elevance Health. Investigate providers and recommend recoveries, sanctions, and policy updates.
Tavsif
- Identify and monitor unusual utilization patterns and potential provider fraud.
- Investigate suspected fraud and overutilization through prepayment claim reviews and post-payment audits.
- Use review findings to guide provider education, fund recovery, cost avoidance, and recommendations for sanctions or other action.
- Coordinate with service operations and other company teams on claim reviews and their status.
- Alert relevant teams to identified issues or providers.
- Recommend updates to medical policy and online policy edits.
Talablar
- Associate degree in nursing and at least two years of clinical nursing experience, or an equivalent combination of education and experience.
- Current unrestricted RN license in the applicable state or states.
- Bachelor’s degree preferred.
- Professional coder certification preferred.
- Strong preference for knowledge of auditing, accounting, and control principles.
- Strong preference for working knowledge of CPT/HCPCS and ICD-9 coding and medical policy guidelines.
- Medical claims review experience and prior healthcare fraud audit or investigation experience preferred.
- Candidates must live within reasonable commuting distance of the posting location unless a legally required accommodation is granted.
- COVID-19 and influenza vaccination is required for certain patient- or member-facing roles unless an acceptable explanation is provided.
Imtiyozlar
- Merit increases
- Paid holidays
- Paid time off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short-term disability benefits
- Long-term disability benefits
- 401(k) matching
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Full-time virtual work, except for required in-person training sessions
- Accommodation for virtual-work commuting-distance requirements where required by law