Clinical Provider Auditor I
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. The Clinical Provider Auditor I is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse, examining claims for compliance, and collaborating with the Special Investigation Unit. Responsibilities 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 Skills Requires a AA/AS and minimum of 1 year related medical coding/auditing experience; or any combination of education and experience, which would provide an equivalent background Must achieve coding certification (CPC, CCS, CPMA) within one year of starting in this position Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology strongly preferred Benefits Comprehensive benefits package Incentive and recognition programs Equity stock purchase 401k contribution Merit increases Paid holidays Paid Time Off Incentive bonus programs Medical Dental Vision Short and long term disability benefits Stock purchase plan Life insurance Wellness programs Financial education resources Company Overview Elevance Health is an integrated whole-health approach to help people in health journey and address their full range of needs. It was founded in 1944, and is headquartered in Indianapolis, Indiana, USA, with a workforce of 10001+ employees. Its website is Company H1B Sponsorship Elevance Health has a track record of offering H1B sponsorships, with 488 in 2025, 604 in 2024, 660 in 2023, 222 in 2022. Please note that this does not guarantee sponsorship for this specific role.