HarrisburgRecruiter Since 2001
the smart solution for Harrisburg jobs

Clinical Provider Auditor I (Remote)

Company: Anthem, Inc
Location: Harrisburg
Posted on: March 28, 2020

Job Description:

Clinical Provider Auditor I (Remote) (PS34763)Location: United StatesNewRequisition #: PS34763Post Date: 13 hours agoYour Talent. Our Vision. At Anthem, Inc ., its a powerful combination, and the foundation upon which were creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.Clinical Provider Auditor IThis role is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse.Primary duties may include, but are not limited to:

  • Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control.
  • Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to accurately document determinations and continue to next step in the claims lifecycle.
  • Researches new healthcare related questions as necessary to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in laws/regulations.
  • Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern.
  • Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation.
  • Requires an Associate degree or equivalent combination of education and experience.
  • Must also achieve coding certification (CPC, CCS, CPMA) within 6 months of starting in this position and have knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology.
  • 1- 3 years related medical coding/auditing experience, no prior fraud/waste abuse experience necessary.Anthem, Inc. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

Keywords: Anthem, Inc, Harrisburg , Clinical Provider Auditor I (Remote), Healthcare , Harrisburg, Pennsylvania

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Healthcare Jobs


Penn Medicine Lancaster General Health - Family Physician, Oxford, PA
Description: Family Medicine Oxford, a primary care practice that is part of Penn Medicine Lancaster General Health Physicians LGHP , is seeking a full or part time family physician that has a passion for small town, (more...)
Company: Penn Medicine Lancaster General Health
Location: Lancaster
Posted on: 03/31/2020

Aide-Geriatric Nurse (Full Time)
Description: Join us for a virtual open interview day on Tuesday April 7th RSVP at the link below and receive a zoom link to join your virtual interview Genesis is one of the nation's leading providers of post-acute (more...)
Company: Larkin Chase Center - Genesis HealthCare
Location: Bowie
Posted on: 03/31/2020

Nurse Practitioner
Description: Apex Integrated Medicine is seeking a Part-Time Nurse Practitioner to assess, advise, and treat patients at our Chambersburg,
Company: Apex Integrated Medicine
Location: Harrisburg
Posted on: 03/31/2020


Registered Nurse (RN)
Description: Position OverviewRegistered Nurse RN is responsible for providing and documenting skilled nursing care in accordance with the developed care plan and physicians orders for each individual patient while (more...)
Company: Aveanna Healthcare
Location: Altoona
Posted on: 03/31/2020

Emergency Room Travel Nurse RN - $55/hour
Description: Nomad Health, the modern healthcare staffing company, seeks an experienced registered nurse for this rewarding travel assignment opportunity.Join
Company: Nomad Health
Location: Harrisburg
Posted on: 03/31/2020

Experienced PRN Mental Health Nurse Practitioner Needed - Chantilly, VA
Description: BC, Experienced PRN Mental Health Nurse Practitioner Needed in Chantilly, VA The incoming provider should have 3 years of clinical mental health experience and will be responsible for the diagnosis (more...)
Company: HCA Healthcare- Urgent Care Division
Location: Chantilly
Posted on: 03/31/2020

Physician / Emergency Medicine / Maryland / Permanent / Emergency Medi
Description: New emergency medicine opening in the suburbs of DC Busy community ED is adding an emergency medicine trained physician
Company: Hayman Daugherty Associates, Inc
Location: Rockville
Posted on: 03/31/2020

Licensed Practical Nurse - LPN - Skilled Nursing Facility
Description: Licensed Practical Nurse - LPN - Skilled Nursing FacilityHere at CareerStaff Unlimited, we are hiring a qualified Licensed Practical Nurse for a full-time contract position at a well-established skilled (more...)
Company: CareerStaff Unlimited
Location: Lancaster
Posted on: 03/31/2020

Physician / Emergency Medicine / Pennsylvania / Permanent / Emergency
Description: High-volume Emergency Medicine Practice in Eastern PA. Have life balance and a balanced emergency medicine
Company: Hayman Daugherty Associates, Inc
Location: Harrisburg
Posted on: 03/31/2020

Speech Pathologist - SLP
Description: Advanced's School Division is currently looking to staff a speech-language pathologist in a school setting in the Harrisburg, PA area. The ideal applicant will be familiar with language, communication, (more...)
Company: Advanced Medical
Location: Harrisburg
Posted on: 03/31/2020

Log In or Create An Account

Get the latest Pennsylvania jobs by following @recnetPA on Twitter!

Harrisburg RSS job feeds