BaltimoreRecruiter Since 2001
the smart solution for Baltimore jobs

SIU Provider Auditor / Provider Auditor Sr.

Company: Anthem, Inc
Location: Columbia
Posted on: February 16, 2020

Job Description:

SIU Provider Auditor / Provider Auditor Sr. - PS32633Location: Cerritos, California, United StatesRequisition #: PS32633Post Date: Jan 23, 2020Your Talent. Our Vision. At Anthem, Inc., its apowerful combination, and the foundation upon which were creating greater accessto care for our members, greater value for our customers, and greater healthfor our communities. Join us and together we will drive the future of healthcare .Thisis an exceptional opportunity to do innovative work that means more to you andthose we serve atoneof 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 arrangementAs 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 certificationAnthem, Inc. is ranked as one of AmericasMost 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.

Keywords: Anthem, Inc, Baltimore , SIU Provider Auditor / Provider Auditor Sr., Accounting, Auditing , Columbia, Maryland

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Accounting, Auditing Jobs


Credentialed Bilingual Tax Advisor - CPA - Remote
Description: Job Description:Overview Join Our Virtual Tax Network At Intuit, our mission is to power prosperity around the world. Tax experts support that mission to our TurboTax customers by: providing valuable (more...)
Company: Intuit
Location: Lancaster
Posted on: 03/1/2020

Bilingual Tax Professional - CPA - Remote
Description: Job Description:Overview Join Our Virtual Tax Network At Intuit, our mission is to power prosperity around the world. Tax experts support that mission to our TurboTax customers by: providing valuable (more...)
Company: Intuit
Location: Lancaster
Posted on: 03/1/2020

Insurance and Financial Sales - LIFE INSURANCE LICENSED REQ'D (Lancaster,PA)
Description: CURRENT LIFE INSURANCE LICENSE REQUIRED TO BE CONSIDERED Are you an individual with a strong desire to succeed in the business world and help families at the same time We have a wide range of mortgage (more...)
Company: The Alliance
Location: Lancaster
Posted on: 03/1/2020


Credentialed Bilingual Tax Advisor - CPA - Remote
Description: Job Description: br br Overview Join Our Virtual Tax Network At Intuit, our mission is to power prosperity around the world. Tax experts support that mission to our TurboTax customers by: providing (more...)
Company: Intuit
Location: Washington
Posted on: 03/1/2020

Bilingual Tax Professional - CPA - Remote
Description: Job Description:Overview Join Our Virtual Tax Network At Intuit, our mission is to power prosperity around the world. Tax experts support that mission to our TurboTax customers by: providing valuable (more...)
Company: Intuit
Location: Reading
Posted on: 03/1/2020

PrtfolioAnl&Stra Spec
Description: Position Overview br br At PNC, our people are our greatest differentiator and competitive advantage in the markets we serve. We are all united in delivering the best experience for our customers. (more...)
Company: PNC Financial Services Group
Location: Wilmington
Posted on: 03/1/2020

Insurance and Financial Sales - LIFE INSURANCE LICENSED REQ'D (Wilmington,DE)
Description: CURRENT LIFE INSURANCE LICENSE REQUIRED TO BE CONSIDERED Are you an individual with a strong desire to succeed in the business world and help families at the same time We have a wide range of mortgage (more...)
Company: The Alliance
Location: Wilmington
Posted on: 03/1/2020

Bilingual Tax Professional - CPA - Remote
Description: Job Description:Overview Join Our Virtual Tax Network At Intuit, our mission is to power prosperity around the world. Tax experts support that mission to our TurboTax customers by: providing valuable (more...)
Company: Intuit
Location: Harrisburg
Posted on: 03/1/2020

Bilingual Tax Professional - CPA - Remote
Description: Job Description:Overview Join Our Virtual Tax Network At Intuit, our mission is to power prosperity around the world. Tax experts support that mission to our TurboTax customers by: providing valuable (more...)
Company: Intuit
Location: Washington
Posted on: 03/1/2020

Senior Associate, Federal Financial Statement Audit
Description: Senior Associate, Federal Financial Statement Audit 1296 br Location: Tysons Corner, VA br The Stone Alliance Group is looking for a Senior Associate
Company: Stone Alliance Group
Location: Washington
Posted on: 03/1/2020

Log In or Create An Account

Get the latest Maryland jobs by following @recnetMD on Twitter!

Baltimore RSS job feeds