Auditor Interno executing auditorias internas defining scopes and mapping processes for Constellation. Supporting internal audit planning and risk management activities.
About the role
- Clinical Provider Auditor II role in Elevance Health's Payment Integrity evaluating claims for fraud prevention. Responsibilities include auditing, compliance checks, and collaborating with internal teams.
Responsibilities
- Supports the Payment Integrity line of business
- Examines claims for compliance with relevant billing and processing guidelines
- Identifies opportunities for fraud and abuse prevention and control
- Reviews and conducts analysis of claims and medical records prior to payment
- Researches new healthcare related questions as necessary to aid in investigations
- Collaborates with the Special Investigation Unit and other internal areas
- Recommends possible interventions for loss control and risk avoidance
- Assists with training of new associates
Requirements
- Requires a AA/AS
- Minimum of 4 years medical coding/auditing experience
- Minimum of 1 year in fraud, waste abuse experience
- Must have coding certification (CPC, CCS, CPMA)
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
- Paid Time Off
- Medical insurance
- Dental insurance
- Vision insurance
- Short and long term disability benefits
- Life insurance
- Wellness programs
- Financial education resources
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