GrandPrairieRecruiter Since 2001
the smart solution for Grand Prairie jobs

Clinical Provider Auditor I (Remote)

Company: Anthem, Inc
Location: Grand Prairie
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, Grand Prairie , Clinical Provider Auditor I (Remote), Accounting, Auditing , Grand Prairie, Texas

Click here to apply!

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

I'm looking for
in category
within


Other Accounting, Auditing Jobs


Hi-Tech Industry - Cognitive & Robotics Process Automation Senior Manager
Description: Our Telecommunications, Media and Technology TMT industry clients include some of the most valued companies in the U.S. and many of the world's top global brands.-- We are poised to help clients shape (more...)
Company: Deloitte
Location: Dallas
Posted on: 04/8/2020

Financial Services Professional - Insurance Agent
Description: Insurance AgentJoin our dependable team.As an Insurance Agent with New York Life, you will help clients achieve their financial goals, while building a great career for yourself in the process. Utilizing (more...)
Company: New York Life
Location: Waxahachie
Posted on: 04/8/2020

Financial Services Professional - Fast Track Partner
Description: Fast Track PartnerGrow with our dependable team.We are currently seeking managers to become part of New York Life's Fast Track Partner program. Are you a leadership-oriented individual You may be selected (more...)
Company: New York Life
Location: Midlothian
Posted on: 04/8/2020


Financial Services Professional - Community Driven
Description: Financial ProfessionalNew York Life Insurance Company, a mutual life insurance company, together with its subsidiaries, provides a range of insurance and investment products and services. The company (more...)
Company: New York Life
Location: Midlothian
Posted on: 04/8/2020

Consulting Manager, Financial Advisory
Description: The multi-faceted role you've been looking for--- Managers play a vibrant, integral role at Huron. Their invaluable knowledge reflects in the projects they manage and the teams they lead. Managers build (more...)
Company: Huron Consulting Group
Location: Dallas
Posted on: 04/8/2020

Senior Risk Analyst - Risk Apeptite
Description: Purpose of JobWe are currently seeking a talented Senior Risk Analyst - Risk Apeptite for the San Antonio Home Office II/III or Plano. br br br Provides risk management support for a line of business (more...)
Company: USAA
Location: Pilot Point
Posted on: 04/8/2020

Supervision and Controls Lead - First Line Credit Risk
Description: Purpose of JobThis position supports the supervision of front-line business units within Bank First Line Credit Risk that are responsible for implementing and adhering to sales and service standard policies (more...)
Company: USAA
Location: Farmersville
Posted on: 04/8/2020

International Tax Technology Implementations - Senior Consultant
Description: Do you have a passion for international tax and technology Want to help pioneer new technology-enabled methods and processes for some of the largest corporate entities on the planet Our team works on (more...)
Company: Deloitte
Location: Dallas
Posted on: 04/8/2020

Credentialed Tax Expert - CPA, Enrolled Agent or Practicing Attorney Seasonal Remote
Description: OverviewIf you are a highly motivated individual with an active unrestricted credential CPA/EA/Practicing Attorney and excellent communication skills, we need you to help our customers complete their (more...)
Company: Intuit
Location: Dallas
Posted on: 04/8/2020

Financial Services Professional - Community Driven
Description: Financial ProfessionalNew York Life Insurance Company, a mutual life insurance company, together with its subsidiaries, provides a range of insurance and investment products and services. The company (more...)
Company: New York Life
Location: Waxahachie
Posted on: 04/8/2020

Log In or Create An Account

Get the latest Texas jobs by following @recnetTX on Twitter!

Grand Prairie RSS job feeds