Provider Auditor Senior
Company: Elevance Health
Posted on: January 28, 2023
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
- 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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