Job Details

ID #2668226
State Louisiana
City Metairie
Full-time
Salary USD TBD TBD
Source Anthem, Inc
Showed 2019-08-30
Date 2019-08-31
Deadline 2019-10-30
Category Et cetera
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Provider Auditor - PS25791

Louisiana, Metairie 00000 Metairie USA

Vacancy expired!

Provider Auditor - PS25791Location: United StatesNewRequisition #: PS25791Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re

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.The Provider Auditor Conducts reviews of medical

charts, medical notes, itemized bills and providers contracts to ensure that a

claim is paid in accordance with the contract, provider reimbursement policies,

and industry standards.Primary duties may include, but are not limited to:

Selects providers to be reviewed based on historicalresults of other reviews with providers, network management input anddollar volume of provider.

Analyzes data to select claims to be reviewed, conductsreview using medical charts, medical notes, itemized bills and providercontracts.

Verifies dollar amount on claim is correct in claimssystem and writes report of the findings of the review and requestspayments for any overpayments.

Identifies aberrant patterns of billing and detectspotential abuse. Participates in developing and/or reviewing departmentpolicies and procedures.

Works on task forces and committees.

Qualifications:

Requires either a BA/BS degree or;certification in a clinical practice or medical coding or providerreimbursement auditing or 2-4 years equivalent work experience preferred;or any combination of education and experience, which would provide anequivalent background.

Licensed LPN, LVN, RN preferred.

CPC - medical coding certification preferred.

Anthem,Inc. is ranked as one of America’s Most Admired Companies among health insurersby Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company forDiversity. To learn more about our company and apply, please visit us atcareers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

Vacancy expired!

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