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Anthem, Inc. Nurse Audit I/Senior in Lexington, Kentucky

Nurse Audit I/Senior

Location: United States


Requisition #: PS34985

Post Date: 1 day ago

Your Talent. Our Vision. At Amerigroup , a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s 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.

Position is work from home, however, must live within commutable distance to an Anthem office.*

Primary duties may include, but are not limited to:

  • Navigating through a medical record for auditing purposes, working knowledge of CPT/HCPCS and ICD- 9 and ICD-10 coding, and medical policy guidelines as it applies to inpatient clinical validation DRG review.

  • Perform post payment audit of submitted medical records.

  • Correlates review findings with appropriate actions including provider education and recovery of monies.

  • Assists with development of audit tools, policies and procedures and education materials.


  • Requires an AS/BS in nursing; 2-4 years of clinical nursing experience; or any combination of education and experience, which would provide an equivalent background.

  • Current unrestricted RN license in applicable state(s) required.

  • Requires knowledge of auditing, accounting and control principles and a working knowledge of CPT/HCPCS and ICD 9 coding and medical policy guidelines.

  • Certified as a Professional Coder preferred.

  • Medical claims review with prior health care fraud audit/investigation experience preferred.

  • Working Knowledge of DRG Validation highly preferred.

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