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Elevance Health · 9 hours ago

Clinical Provider Auditor II (US)

Chicago, IL

Full-time

Hybrid

Mid Level

$55K/yr - $105K/yr

3+ years exp

Elevance Health is a health company dedicated to improving lives and communities. They are seeking a Clinical Provider Auditor II responsible for identifying potential risks associated with fraud and abuse in healthcare claims.

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

Assists with training of new associates

Qualification

Medical coding certificationFraudWasteAbuse experienceICD-10 coding knowledgeCPT/HCPC coding knowledgeMS Excel proficiencyMS Word proficiencyAnalytical skillsTraining skillsCollaboration skills

Required

Requires a AA/AS and minimum of 3 years medical coding/auditing experience, including minimum of 1 year in fraud, waste abuse experience; or any combination of education and experience, which would provide an equivalent background

Requires coding certification (CPC, CCS, CPMA)

Preferred

Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology

Bachelors degree strongly preferred

Experience coding for different specialties preferred

Strong knowledge of MS Excel and Word highly 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

401(k) +match

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

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Trends of Total Sponsorships

2025 (488)

2024 (604)

2023 (660)

2022 (222)