Provider Auditor

WARNING: Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Elevance Health requires a completed online application for consideration of employment for any position. We will never ask you for a credit card, send you a check, or ask you for payment as part of consideration for employment.Provider Auditor

Job Family: PND > Provider Relationship Account Mgmt

Type: Full time

Date Posted:Feb 07, 2024

Anticipated End Date:Feb 21, 2024

Reference: JR102517

Location:

TN, BRENTWOOD

OH, MASON

KY, LOUISVILLE

IN, INDIANAPOLIS

VA, NORFOLK

DescriptionLocation : This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.Hybrid Workplace Strategy: 1-2 days in office per weekThe Provider Auditor conducts reviews of provider data to ensure that a claim is paid in accordance with the contract, provider reimbursement policies, and industry standards.How you will make an impact:

Selects providers to be reviewed based on PDM criteria, historical results with providers, network management input and dollar volume of provider.

Conducts review of submitted information and provider contracts using PDM policies to assess for fraud, waste, and abuse.

Verifies submitted information is valid and correct in system and documents the findings of the review.

Conducts interview with provider to verify preliminary review results and variance from PDM policies.

Identifies aberrant email, funds transfer requests, and detects potential abuse.

Participates in developing and/or reviewing department policies and procedures. Works on task forces and committees.

Minimum Requirements: Requires either a BA/BS degree, medical coding certification and a minimum of 2 years’ relevant work experience; or any combination of education and experience, which would provide an equivalent background.Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.Who We AreElevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.How We WorkAt Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.EEO is the LawEqual Opportunity Employer / Disability / Veteran Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.

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