Senior Clinical Quality Auditor performing internal audits, analyzing results, and collaborating with clinical operations teams at DaVita. Assisting leadership with daily operations of the Clinical Quality Auditing team.
About the role
- Provider Auditor Senior at Elevance Health conducting audits on medical claims and ensuring compliance with contracts. Analyzing data and mentoring staff while working in a hybrid environment.
Responsibilities
- conducts on-site reviews of medical charts, medical notes, itemized bills and provider contracts
- selects providers to be reviewed based on historical results of other reviews with providers
- 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
- writes report of the findings of the review
- 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
- a minimum of 3 years equivalent work experience
- Certification as a Professional Coder preferred
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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