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Anthem, Inc. SIU Provider Auditor / Provider Auditor Sr. - PS32633 in Anaheim, California

SIU Provider Auditor / Provider Auditor Sr. - PS32633

Location: Cerritos, California, United States

New

Requisition #: PS32633

Post Date: 3 days ago

Your 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 healthcare .

This is an exceptional opportunity to do innovative work that means more to you and those we serve atone of America's leading health benefits companies and a Fortune Top 50 Company.

SIU Provider Auditor or SIU Provider Auditor Sr.

Cerritos, CA - will also consider a remote arrangement

As an auditor for the Special Investigation Unit (SIU) this position 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 that are flagged to be reviewed based on a pre-pay basis using historical results of other reviews with providers, aberrant patterns of billing, network management input and dollar volume of provider.

  • Verifies dollar amount on claim is correct in claims system and writes report of the findings of the review and requests payments for any over payments.

  • Identifies aberrant patterns of billing and detects potential abuse. Mentors and trains Provider Auditor as needed.

  • Drafts department policies and procedures and other educational materials.

  • Works on task forces and committees representing functional area.

Provider Auditor:

Requires either a BA/BS degree, medical coding certification (CPC), 2-4 years equivalent work experience; or any combination of education and experience, which would provide an equivalent background.

Provider Auditor Sr.:

Requires either a BA/BS degree, medical coding certification (CPC), 5 years equivalent work experience; or any combination of education and experience, which would provide an equivalent background.

Medicare claims experience is required for both job levels.

Preferred skill sets include:

  • RN degree

  • Strong written and verbal communication skills

  • Intermediate knowledge level of Microsoft Office (Word, Excel, Outlook)

  • Familiarity with coding software (i.e. EncoderPro)

  • Member of Health Care Anti-Fraud Associate (HCAFA) or FWA certification

Anthem, Inc. is ranked as one of America’sMost Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityIncmagazine Top 50 Company for Diversity. To learn more about our company andapply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

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