Job Details

ID #2822660
Estado New Jersey
Ciudad Iselin
Full-time
Salario USD TBD TBD
Fuente Anthem
Showed 2019-11-01
Fecha 2019-11-01
Fecha tope 2019-12-30
Categoría Etcétera
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Clinical Provider Auditor II-Remote (PS28974)

New Jersey, Iselin 00000 Iselin USA

Vacancy caducado!

Clinical Provider Auditor II-Remote (PS28974)Location: United StatesNewRequisition #: PS28974Clinical Provider Auditor II –PS28974This position has the ability to work remoteResponsible 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.

Assists with training of new associates.

Qualifications:

Requires an Associate or Bachelor’s degree or equivalent combination of education and experience.

Must possess coding certification (CPC, CCS, CPMA) and have knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology.

4 years medical coding/auditing experience; 1 years in fraud, waste abuse experience.AnEqualOpportunityEmployer/Disability/Veteran

Vacancy caducado!

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