CharlestonWVRecruiter Since 2001
the smart solution for Charleston jobs

Clinical Provider Auditor I (Remote)

Company: Anthem, Inc
Location: Charleston
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, Charleston , Clinical Provider Auditor I (Remote), Healthcare , Charleston, West Virginia

Click here to apply!

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

I'm looking for
in category
within


Other Healthcare Jobs


Registered Nurse 6pm-6am
Description: A stronger bond with patients A stronger impact on recovery BE THE CONNECTION. As a registered nurse RN , you'll be the connection between compassionate care and the real, positive results your patients (more...)
Company: Encompass Health
Location: Huntington
Posted on: 04/1/2020

RRT Registered Respiratory Therapist - Adults-Relocation to VA
Description: Job Summary br 3,000 SIGN ON BONUS for Experienced RRTs. br br Adults. Full time, night shift, every other weekend required. One 12 hour on call shift may be required each week. Three 12 hour shifts (more...)
Company: Carilion Clinic
Location: Charleston
Posted on: 04/1/2020

Physician / Hospitalist / West Virginia / Locum tenens / Locums Hospit
Description: Hospitalist needed in South Charleston, WVThis is a locums/contract position
Company: Echo Locum Tenens!
Location: Charleston
Posted on: 04/2/2020


Travel RN-PCU/Stepdown - Charleston, WV (RN #)
Description: ul li RNnetwork has an excellent travel opportunity for a provider experienced in the following specialty: RN-PCU/Stepdown. This opportunity will be available
Company: RNnetwork
Location: Charleston
Posted on: 04/2/2020

Travel Nurse RN - Oncology - $1,555 per week
Description: trustaff is seeking a travel nurse RN Oncology for a travel nursing job in Delray Beach, Florida:- Specialty: Oncology- Discipline: RN- Start Date: ASAP- Duration: 13 weeks- 36 hours per week- Shift: (more...)
Company: NurseFly Travel Nursing
Location: Charleston
Posted on: 04/2/2020

Physician / Hospitalist / West Virginia / Locum tenens / Hospitalist n
Description: Hospitalist need in Charleston, WVStart date August projected 6-9 monthsClient is using project time to recruit and onboard perm docs580 bed hospitalHos does admissions from 7-4 - roundingShifts are (more...)
Company: Aya Locums
Location: Charleston
Posted on: 04/1/2020

Travel Nurse RN - Intermediate Care - $1,544 per week
Description: Accountable Healthcare Staffing is seeking a travel nurse RN Intermediate Care for a travel nursing job in Charleston, West Virginia:- Specialty: Intermediate Care- Discipline: RN- Start Date: ASAP- Duration: (more...)
Company: NurseFly Travel Nursing
Location: Charleston
Posted on: 04/2/2020

Physician / Hospitalist / West Virginia / Permanent / Hospitalist Phys
Description: Hospitalist Position in West Virginia Just 45 minutes from Charleston, West Virginia, a regional medical center is
Company: Hayman Daugherty Associates, Inc
Location: Charleston
Posted on: 04/1/2020

Licensed Practical Nurse (Full Time)
Description: br Genesis is one of the nation's leading providers of post-acute healthcare services from short-term to long-term care and a wide variety of living options and professional clinical services. We are (more...)
Company: Heritage Center - Genesis HealthCare
Location: Huntington
Posted on: 04/1/2020

Travel Nurse RN - Progressive Care Unit - $1,473 per week
Description: LRS Healthcare is seeking a travel nurse RN Progressive Care Unit for a travel nursing job in Charleston, West Virginia:- Specialty: Progressive Care Unit- Discipline: RN- Start Date: 04/23/2020- Duration: (more...)
Company: NurseFly Travel Nursing
Location: Charleston
Posted on: 04/2/2020

Log In or Create An Account

Get the latest West Virginia jobs by following @recnetWV on Twitter!

Charleston RSS job feeds