Apply on Employer Site

Elevance Health · 21 hours ago

Clinical Provider Auditor I

Atlanta, GA

Full-time

Hybrid

Entry Level

$25.26/hr - $47.85/hr

1+ years exp

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.

Health CareHealth InsurancePersonal HealthWellness

H1B Sponsor Likely

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

Qualification

Medical coding certificationICD-10 coding knowledgeCPT/HCPC coding knowledgeClaims analysisFraud preventionResearch skillsCollaboration

Required

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

Preferred

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

Elevance Health

Glassdoor3.6

Elevance Health is an integrated whole-health approach to help people in health journey and address their full range of needs.

Founded in 1944

Indianapolis, Indiana, USA

10001+ employees

https://www.elevancehealth.com

H1B Sponsorship

Elevance Health has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (488)

2024 (604)

2023 (660)

2022 (222)