Provider Auditor Senior

Elevance Health • Indianapolis, IN

5d • Hybrid

About The Position

Provider Auditor Senior - Audit Location: Atlanta, GA; Norfolk, VA & Indianapolis, IN Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Provider Auditor Senior 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. How you will make an impact: 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.

Requirements

• Requires a BA/BS degree and a minimum of 3 years equivalent work experience; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

• Certification as a Professional Coder preferred.

Responsibilities

• 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.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Number of Employees: 5,001-10,000 employees