Overview: A Lifetime Health Partner
Driven by our mission to improve global health, we’re evolving beyond a traditional health benefits company to become a trusted health partner throughout your life.
Our team of nearly 100,000 associates serves over 118 million people, supporting them at every stage of their health journey. We address a wide range of needs through an integrated, holistic health approach, powered by our industry-leading capabilities and a robust digital health platform.
We firmly believe that better health for all is achievable. This starts with redefining what health means, reimagining the healthcare system, and strengthening the communities we serve.
Provider Auditor: Hybrid Role at Elevance Health
We’re looking for a Provider Auditor to join our team at Carelon Payment Integrity, a proud part of the Elevance Health family. Carelon Insights is dedicated to recovering, eliminating, and preventing unnecessary medical expenses. This is a hybrid position, requiring one in-office day per week, so you’ll need to live within 50 miles of one of our Elevance Health PulsePoint locations.
How You’ll Make an Impact
In this role, you’ll be crucial in ensuring claims are paid correctly. You’ll do this by:
- Selecting providers for review based on past results, network management input, and the provider’s claim volume.
- Analyzing data to choose specific claims, then conducting thorough reviews using medical charts, notes, and provider contracts.
- Verifying claim amounts in our system and reporting findings, including requesting payments for any overpayments.
- Identifying unusual billing patterns and detecting potential abuse.
- Contributing to the development and review of department policies and procedures.
- Participating in task forces and committees.
Qualifications
Minimum Requirements:
- A BA/BS degree and at least 2 years of relevant work experience, or an equivalent combination of education and experience.
- An RN, LPN, or medical coding certification is strongly preferred.
Preferred Skills & Experience:
- Medical coding certification is highly preferred.
- Strong understanding of contract language and federal guidelines.
- Experience working with Facets software.
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