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Provider Auditor Senior

Company: Elevance Health
Location: Denver
Posted on: January 28, 2023

Job Description:

Conducts on-site reviews of medical charts, medical notes, itemized bills and providers contracts to ensure that a claim is paid in accordance with the contract, provider reimbursement policies, and industry standards. Primary duties may include, but are not limited to:

  • Selects providers to be reviewed based on historical results of other reviews with providers, network management input and dollar volume of provider.
  • Schedules review with provider, analyzes data to select claims to be reviewed, conducts review using medical charts, medical notes, itemized bills and provider contracts.
  • Conducts exit interview with provider management team by presenting preliminary review results.
  • Verifies dollar amount on claim is correct in claims system and writes report of the findings of the review and requests payments for any overpayments.
  • Identifies aberrant patterns of billing and detects potential abuse.
  • Mentors and trains Provider Auditor as needed.
  • Drafts department policies and procedures and other educational materials. Works on task forces and committees representing functional area. Requires either a BA/BS degree, medical coding certification and a minimum of 3 years equivalent work experience; or any combination of education and experience, which would provide an equivalent background. RN or medical coding certification strongly preferred . For candidates working in person or remotely in the below locations, the salary* range for this specific position is $67,040 to $115,644 Locations: California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws . * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Keywords: Elevance Health, Denver , Provider Auditor Senior, Accounting, Auditing , Denver, Colorado

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