PaloAltoRecruiter Since 2001
the smart solution for Palo Alto jobs

Clinical Provider Auditor I (Remote)

Company: Anthem, Inc
Location: Palo Alto
Posted on: March 28, 2020

Job Description:

Clinical Provider Auditor I (Remote) (PS34763)Location: United StatesNewRequisition #: PS34763Post Date: 13 hours agoYour Talent. Our Vision. At Anthem, Inc ., its a powerful combination, and the foundation upon which were 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 at one of America's leading health benefits companies and a Fortune Top 50 Company.Clinical Provider Auditor IThis role is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse.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 next step in the claims lifecycle.
  • Researches new healthcare related questions as necessary to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in laws/regulations.
  • Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern.
  • Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation.
  • Requires an Associate degree or equivalent combination of education and experience.
  • Must also achieve coding certification (CPC, CCS, CPMA) within 6 months of starting in this position and have knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology.
  • 1- 3 years related medical coding/auditing experience, no prior fraud/waste abuse experience necessary.Anthem, Inc. is ranked as one of Americas 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 careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

Keywords: Anthem, Inc, Palo Alto , Clinical Provider Auditor I (Remote), Healthcare , Palo Alto, California

Click here to apply!

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

I'm looking for
in category
within


Other Healthcare Jobs


Emergency Room Nurse - Emergency Nurse - Travel - (ER RN)
Description: Job Description Requirements br br Emergency Room Nurse - Emergency Nurse - ER RN br br StartDate: ASAP Available Shifts: 12 D/E Pay Rate: 2381.00 - 2625.00 br br This Emergency Room (more...)
Company: American Mobile Healthcare
Location: Novato
Posted on: 04/10/2020

Travel Nurse (RN) Med/Surg (Medical-Surgical)
Description: This is a travel Nurse - Med/Surg assignment in Petaluma, CA, working nights. Don't miss this exciting Medical-Surgical travel RN
Company: Emerald Health Services
Location: Petaluma
Posted on: 04/10/2020

RN / REGISTERED NURSE / ER RN / EMERGENCY ROOM NURSE
Description: Job Reference Number: 20-1115373 br br Level II, 272 bed hospital 7 minutes from the Beach is in need of a ER nurse for 13 weeks. This hospital will look
Company: Aureus Medical Group
Location: Santa Cruz
Posted on: 04/10/2020


BHRS Utilization Review Specialist - Mental Health Practitioner, Temporary
Description: ABOUT USAt the County of Marin, our employees overwhelmingly report feeling their work is meaningful, they like the work they do, and they are proud to tell people I work for the County of Marin. Discover (more...)
Company: County of Marin
Location: San Rafael
Posted on: 04/10/2020

Lab Technician
Description: br br br Job Description: Stanford Blood Center, a subsidiary of Stanford Health Care, is focused on connecting our communities to provide hope for healing. We lead the fields of transfusion and (more...)
Company: Stanford Health Care
Location: Newark
Posted on: 04/10/2020

Home Health Aide
Description: Take advantage of this unique opportunity to learn the fundamentals of quality home care and deliver life-changing service to your clients. As an Arcadia Home Health Aide, you---ll play a vital role in (more...)
Company: Arcadia Home Care and Staffing
Location: San Rafael
Posted on: 04/10/2020

Public Health Nurse II - Communicable Disease Prevention and Control (Temporary)
Description: ABOUT USAt the County of Marin, our employees overwhelmingly report feeling their work is meaningful, they like the work they do, and they are proud to tell people I work for the County of Marin. Discover (more...)
Company: County of Marin
Location: San Rafael
Posted on: 04/10/2020

Speech Language Pathologist - School
Description: Speech Language Pathologist School br br Location: San Rafael, CA br br Job ID: 34629 br br Start Date: 2019-11-18 br br End Date: 2020-06-16 br br Status: open br br Description (more...)
Company: Preferred Healthcare Staffing
Location: San Rafael
Posted on: 04/10/2020

Telemetry Nurse - Travel - (Tele RN)
Description: Job Description Requirements br br Telemetry Nurse - Tele RN br br StartDate: 04/27/2020Available Shifts: 12 D Pay Rate: 2250.00 - 2481.00 br br Exclusive order to AMN. Established in (more...)
Company: American Mobile Healthcare
Location: San Rafael
Posted on: 04/10/2020

Clinical Psychologist II - Assisted Outpatient Treatment
Description: ABOUT USAt the County of Marin, our employees overwhelmingly report feeling their work is meaningful, they like the work they do, and they are proud to tell people I work for the County of Marin. Discover (more...)
Company: County of Marin
Location: San Rafael
Posted on: 04/10/2020

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Palo Alto RSS job feeds