Clinical Provider Auditor

Welcome to Elevance Health, where we are dedicated to improving the quality of healthcare for all individuals through innovation and collaboration. We are currently seeking a highly motivated and detail-oriented Clinical Provider Auditor to join our growing team. As a Clinical Provider Auditor, you will play a crucial role in ensuring the accuracy and compliance of medical claims and services provided by our network of healthcare providers. If you have a passion for healthcare and a strong background in auditing, we want to hear from you! Read on to learn more about the qualifications and responsibilities of this exciting opportunity.

1. Conduct thorough and accurate audits of medical claims and services provided by healthcare providers within our network.
2. Review and analyze medical records to ensure proper documentation and coding of services rendered.
3. Identify and investigate potential fraudulent or incorrect billing practices.
4. Collaborate with healthcare providers to educate and train on proper coding and billing procedures.
5. Communicate audit findings and provide recommendations for improvement to management.
6. Stay up-to-date on industry regulations and compliance standards to ensure adherence in all audit processes.
7. Develop and maintain audit tools and templates to streamline the auditing process.
8. Assist in the development and implementation of policies and procedures related to provider auditing.
9. Work closely with other departments to ensure timely and accurate processing of claims and payments.
10. Serve as a subject matter expert on audit processes and provide guidance to colleagues and healthcare providers as needed.
11. Proactively identify areas for process improvement and make recommendations to management.
12. Collaborate with cross-functional teams to resolve any issues related to provider claims and services.
13. Maintain confidentiality of all sensitive information in accordance with HIPAA regulations.
14. Meet audit productivity and accuracy standards set by the company.
15. Participate in training and professional development opportunities to enhance knowledge and skills related to provider auditing.
16. Foster a positive and collaborative work environment within the audit team and across the organization.

According to JobzMall, the average salary range for a Clinical Provider Auditor in Indianapolis, IN, USA is between $50,000-$90,000 per year. This can vary depending on the specific job title, experience level, and company. Additionally, factors such as education, certifications, and additional skills may also impact salary.

Elevance Health, Inc. is an American health insurance provider. The company's services include medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans through affiliated companies such as Anthem Blue Cross and Blue Shield, Empire BlueCross BlueShield in New York State, Anthem Blue Cross in California,Wellpoint, and Carelon.It is the largest for-profit managed health care company in the Blue Cross Blue Shield Association. As of 2022, the company had 46.8 million members within their affiliated companies' health plans. Prior to June 2022, Elevance Health was named Anthem, Inc.