Elevance Health · 9 hours ago
Clinical Provider Audit Lead
Atlanta, GA
Full-time
Hybrid
Senior Level
5+ years expElevance Health is a health company dedicated to improving lives and communities, and they are seeking a Clinical Provider Audit Lead. This role is responsible for leading the professional audit program for a region, managing vendor relationships, and conducting complex audits while ensuring compliance with contractual terms.
Health CareHealth InsurancePersonal HealthWellness
Responsibilities
Leads day-to-day activities of the audit team, providing allocation of resources, establishing priorities, and serving as resource to lower-leveled audit associates
Manages vendor relationships with contracted vendors
Periodically audits work of vendors and ensures that terms of contract are being satisfied
Conducts provider meetings to discuss audit findings and appeals for most complex audits. Negotiates settlements
Researches claims payment methodologies and fee schedule pricing of claims. Adjusts and re-prices claims per audit findings
Assists in resolving contractual issues with providers and in reviewing audit process, policy and procedures
Prepares and analyzes various reports to demonstrate recoveries and potential issues with providers
Assists manager with reimbursement/audit initiatives as identified
Supports enterprise initiatives and develops educational materials for internal staff and providers
Qualification
Required
Requires a BA/BS and minimum of 5 years experience in a related field, which could include provider audit, reimbursement; or any combination of education and experience, which would provide an equivalent background
Preferred
Experience related to medical coding, including coding certification and a clinical background, project management and leadership experience strongly preferred
Benefits
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
Elevance Health is an integrated whole-health approach to help people in health journey and address their full range of needs.
10001+ employees
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)
Funding
Current Stage
Public CompanyTotal Funding
unknown2001-10-30IPO
Leadership Team
Gail K. Boudreaux
President and CEO
Geeta Wilson
Chief Technology Officer (CTO): Digital Health and Service Experience Platforms
Recent News
2026-01-25
Company data provided by crunchbase