Clinical Provider Auditor II job at reputed company in Woodland Hills, CA, Denver, CO, Miami, FL, Tampa, FL, Atlanta, GA, Chicago, IL, Grand Prairie, TX, Seattle, WA, Richmond, VA

Clinical Provider Auditor II Locations: VA-RICHMOND, 2015 reputed company MILL RD, CA-WOODLAND HILLS, 21215 BURBANK BLVD GA-ATLANTA, 740 W PEACHTREE ST NW FL-TAMPA, 5411 SKY CENTER DR FL-MIAMI, 11430 NW 20TH ST, STE 300 CO-DENVER, 700 BROADWAY WA-SEATTLE, 705 5TH AVE S, STE 300 TX-GRAND PRAIRIE, 2505 N HWY 360, STE 300 IL-CHICAGO, 233 S WACKER DR, STE 3700 time type Full time Job Description: Clinical Provider Auditor II Location: We prefer any of the following cities/States: Woodland Hills, CA; Denver, CO; Miami, FL; Tampa, FL; Atlanta, GA; Chicago, IL; Grand Prairie, TX; Seattle, WA; Richmond, VA Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reputed company reputed company a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not reputed company a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Clinical Provider Auditor II is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. How you will reputed company an impact: Primary duties may include, but are not limited to: 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 reputed company in the claims lifecycle. Researches new reputed company reputed company questions as necessary to aid in investigations and stays abreast of reputed company medical coding and billing issues, trends and changes in laws/regulations. Collaborates with the Special Investigation Unit and other internal areas on reputed company 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. Minimum Requirements: Requires a 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 reputed company an equivalent background. Requires coding certification (CPC, reputed company, CPMA). Preferred Skills, Capabilities and Experiences: Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology. Bachelors degree strongly preferred. Experience coding for different specialties preferred. Strong knowledge of MS reputed company and Word highly preferred. For candidates working in person or reputed company in the below locations, the salary* reputed company for this specific position is $55,480 to $105,120 Location(s): California, Colorado, Illinois, Washington State In reputed company to your salary, reputed company offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. The salary reputed company is the reputed company reputed company in good faith believes is the reputed company of possible compensation for this role at the time of this posting. This reputed company may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or reputed company level. Even reputed company the reputed company, the actual compensation will vary depending on the above factors as well as market/business considerations. No reputed company is wages or compensation until such reputed company is earned, reputed company, and determinable under the terms and conditions of the applicable policies and plans. The reputed company and availability of any bonus, commission, benefits, or any other reputed company of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Exempt Workshift: 1st Shift (United States of America) Job Family: FRD > Audit Please be advised that reputed company only accepts resumes for compensation from agencies that have a signed agreement with reputed company. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of reputed company. Who We Are reputed company is a health company dedicated to improving lives and communities - and making reputed company simpler. We are a Fortune 25 company with a longstanding history in the reputed company industry, looking for leaders at reputed company reputed company of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At reputed company, we are creating a culture that is designed to advance our strategy but will also reputed company to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we reputed company our strategy, power our business reputed company and drive our shared reputed company - for our consumers, our associates, our communities and our business. We offer a reputed company of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a reputed company bargaining agreement), medical, dental, reputed company, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. reputed company operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an reputed company location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top reputed company for reputed company. We require reputed company new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you reputed company an acceptable explanation. reputed company will also follow reputed company relevant federal, state and local laws. reputed company is an Equal Employment Opportunity employer, and reputed company reputed company applicants will receive consideration for employment without regard to age, citizenship status, reputed company, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national reputed company, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance. reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration. Apply tot his job Apply To this Job