Payment Integrity Auditor I

Premera Blue Cross•Mountlake Terrace, WA

7d•Hybrid

About The Position

As Payment Integrity Auditor I , you will support the overall objectives of the Payment Integrity office. This role is responsible for conducting pre-payment and post-payment claim audits to identify improper payments due to billing errors, coding discrepancies, and policy non-compliance. Audits include reviewing medical records, applying clinical and coding knowledge, analyzing provider billing patterns, and evaluating related claim history to ensure accurate payment integrity. You must be able to clearly document and communicate audit results and collaborate with internal teams including the Special Investigation Unit and Payment Integrity Specialists. This role requires medical coding experience and solid written and oral communication. This is a hybrid role located on our campus in Mountlake Terrace, Washington.

Requirements

Bachelor's Degree or equivalent combination of education and experience.
(1) year of related medical coding or auditing experience.
Certified Professional Coder Designation (CPC-A, CPC, CSS, CPMA) or equivalent.
Basic understanding of CPT, HCPCS, ICD-10-CM, and DRG coding.
Strong attention to detail and analytical thinking.
Effective written and verbal communication skills.

Nice To Haves

Knowledge of health plan operations and claim adjudication processes.
Experience with facility, professional, and ancillary coding.
Familiarity with auditing software tools.

Responsibilities

Conduct entry-level audits of professional and facility claims to ensure coding accuracy and compliance with contractual, coding, payment policy, and regulatory standards.
Review itemized bills, medical records, and other claim documentation to verify coding accuracy and appropriateness of charges.
Validate coding accuracy for CPT, HCPCS, ICD-10-CM, and DRG.
Identify and report coding discrepancies or errors and recommend adjustments where appropriate.
Identify opportunities for fraud, waste, and abuse prevention and control.
Maintain accurate and detailed records of audit findings and outcomes for reporting purposes.
Collaborate with internal teams (e.g., claims processing, provider relations, special investigations unit).
Utilize auditing software and systems to document, track, and analyze claims data.
Stay updated on coding guidelines, payer policies, and industry standards, including CMS regulations.
Participate in ongoing training and development to enhance coding and auditing skills.
Support Payment Integrity team initiatives by contributing to process improvement efforts and team goals.

Benefits

Medical, vision, and dental coverage with low employee premiums.
Voluntary benefit offerings, including pet insurance for paw parents.
Life and disability insurance.
Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.
Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.
Generous paid time off to reenergize.
Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.
Employee recognition program to celebrate anniversaries, team accomplishments, and more.
For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.
Commuter perks make your trip to work less impactful on the environment and your wallet.
Free convenient on-site parking.
Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.