Clinical Provider Auditor I - Maryland Behavioral Health
$58k/y-$87k/y
a day ago
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HybridFull-timeEntry
Summary
Elevance Health is seeking a Clinical Provider Auditor I to join their team in Maryland. The role involves supporting the Payment Integrity line of business by identifying potential risks associated with fraud and abuse in medical claims.
About the Role
As a Clinical Provider Auditor I, you will examine claims for compliance with billing and processing guidelines, conduct analysis of claims and medical records, and collaborate with the Special Investigation Unit. You will also research healthcare-related questions and recommend interventions for loss control and risk avoidance.
About You
Required:
- AA/AS degree and a minimum of 1 year related medical coding/auditing experience.
- Must achieve coding certification (CPC, CCS, CPMA) within 6 months of starting in this position.
Preferred:
- Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology.
- Behavioral Health coding and auditing experience.
Benefits
- Comprehensive benefits package including medical, dental, and vision coverage.
- Incentive and recognition programs.
- Equity stock purchase and 401k contribution.
Elevance Health
Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner. Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health. We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.
Annapolis, MD