Elevance Health · 2 hours ago
Clinical Provider Auditor II
Grand Prairie, TX
Full-time
Hybrid
Mid Level
3+ years expElevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. The Clinical Provider Auditor II will be responsible for identifying issues related to fraud and abuse in healthcare claims and ensuring compliance with billing guidelines.
Health CareHealth InsurancePersonal HealthWellness
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
Required
Requires 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
E/M leveling experience
Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology
Bachelors degree
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