Hybrid Healthcare Auditor II - Fraud & Compliance

Elevance Health9 months ago
Louisville, KY, United States
Hybrid
Full-time
Junior Level (1-3 years)

Job Description

Position Overview

A leading health company is seeking a Clinical Provider Auditor II in Location: Louisville, Kentucky. This role involves examining claims for compliance and identifying fraud risks. The position offers a hybrid work model requiring Schedule: 1-2 days in-office and emphasizes professional growth through structured engagement. It presents a unique opportunity to contribute significantly to healthcare quality and safety.

Key Responsibilities

  • Examine claims for compliance with established healthcare guidelines.
  • Identify and report potential fraud risks.
  • Conduct audits rigorously to help safeguard overall healthcare quality and safety.

Required Qualifications

  • Experience Required: Minimum of 3 years' experience in medical coding.
  • Qualifications: Relevant certifications in medical coding.

Required Skills

Fraud Detection
Risk Management
Medical Coding
Compliance Auditing
Healthcare Quality Assurance
Claims Examination