Payment Integrity Auditor I

Premera Blue Cross is dedicated to improving healthcare for its customers, and they are seeking a Payment Integrity Auditor I. In this role, you will conduct audits to ensure coding accuracy and compliance while collaborating with various internal teams. Responsibilities Conduct entry-level audits of professional and facility claims to ensure coding accuracy and compliance with contractual, coding, payment policy, and regulatory standards Review itemized bills, medical records, and other claim documentation to verify coding accuracy and appropriateness of charges Validate coding accuracy for CPT, HCPCS, ICD-10-CM, and DRG Identify and report coding discrepancies or errors and recommend adjustments where appropriate Identify opportunities for fraud, waste, and abuse prevention and control Maintain accurate and detailed records of audit findings and outcomes for reporting purposes Collaborate with internal teams (e.g., claims processing, provider relations, special investigations unit) Utilize auditing software and systems to document, track, and analyze claims data Stay updated on coding guidelines, payer policies, and industry standards, including CMS regulations Participate in ongoing training and development to enhance coding and auditing skills Support Payment Integrity team initiatives by contributing to process improvement efforts and team goals Skills Bachelor's Degree or equivalent combination of education and experience (1) year of related medical coding or auditing experience Certified Professional Coder Designation (CPC-A, CPC, CSS, CPMA) or equivalent Knowledge of health plan operations and claim adjudication processes Experience with facility, professional, and ancillary coding Familiarity with auditing software tools Benefits Medical, vision, and dental coverage with low employee premiums. Voluntary benefit offerings, including pet insurance for paw parents. Life and disability insurance. Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service. Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few. Generous paid time off to reenergize. Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees. Employee recognition program to celebrate anniversaries, team accomplishments, and more. Commuter perks make your trip to work less impactful on the environment and your wallet. Free convenient on-site parking. Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable. Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more. Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling. Company Overview Premera is a leading health plan in the Pacific Northwest, providing comprehensive health benefits and tailored services. It was founded in 1945, and is headquartered in Mountlake Terrace, Washington, USA, with a workforce of 1001-5000 employees. Its website is Company H1B Sponsorship Premera Blue Cross has a track record of offering H1B sponsorships, with 3 in 2026, 20 in 2025, 29 in 2024, 13 in 2023, 25 in 2022, 15 in 2021, 5 in 2020. Please note that this does not guarantee sponsorship for this specific role.