Job description
- Job Family: PND > Provider Relationship Account Mgmt
- Type: Full time
- Date Posted: Nov 29, 2022
- Req #: JR38524
Description
Title : Provider Auditor LD
Location: WFH/Remote; candidate does not need to reside in posted state
Build the Possibilities. Make an extraordinary impact.
The Provider Auditor LD leads the professional audit program for a region and manages the work of vendors contracted to perform audits on the company's behalf.
- Leads day-to-day activities of the audit team creating and managing workflow assignments, establishing priorities, and serving as resource for training to lower-leveled audit associates.
- Operates as the SME (subject matter expert for a specific line of business as assigned and documents workflow processes.
- Collaborates across business lines through the facilitation of meetings.
- Conducts provider meetings to discuss audit findings and appeals for most complex audits. Negotiates settlements.
- Research claims payment methodologies and fee schedule pricing of claims.
- Reviews and responds to state complaints and prepares cases to escalate for additional review.
- Adjusts and re-prices claims per audit findings.
- Assists in resolving contractual issues with providers and in reviewing audit process policy and procedures.
- Prepares and analyzes various reports to demonstrate recoveries and potential issues with providers.
- Assists manager with reimbursement/audit initiatives as identified.
- Supports enterprise initiatives and develops educational materials for internal staff and providers.
- Requires a BA/BS degree and a minimum of 5 years’ experience in a related field to include provider audit reimbursement and analytics; project management and leadership experience; or any combination of education and experience which would provide an equivalent background.
- Experience related to medical coding including coding certification and a clinical background strongly preferred.
- Experience leading projects preferred.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
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.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.
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