HaciendaHeightsRecruiter Since 2001
the smart solution for Hacienda Heights jobs

Clinical Provider Auditor I (Remote)

Company: Anthem, Inc
Location: Hacienda Heights
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, Hacienda Heights , Clinical Provider Auditor I (Remote), Accounting, Auditing , Hacienda Heights, California

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


Call Center Collection Specialist (Portuguese)
Description: Join one of the top 20 auto finance companies in the industry and grow with us We offer in-house promotions, great benefits, work-life balance, and job stability. If you're looking to work for a rewarding (more...)
Company: Lobel Financial
Location: Anaheim
Posted on: 04/3/2020

Director of Financial Planning & Analysis
Description: Alorica is seeking a smart, detail-oriented Director of Financial Planning Analysis to join its Corporate FP A team, supporting multiple functional groups within the organization, in particular our (more...)
Company: Alorica
Location: Irvine
Posted on: 04/3/2020

Senior Manager, Tax Accounting
Description: Aerojet Rocketdyne is a world-recognized aerospace and defense leader providing propulsion and energetics to its space, missile defense, strategic, tactical missile and armaments customers throughout (more...)
Company: Aerojet Rocketdyne
Location: El Segundo
Posted on: 04/3/2020


Director of Operations
Description: Mike Cox Mike.Cox roberthalf.com of Robert Half, is partnered with a high growth, entrepreneurial fashion client in Culver City, with their recruitment of a Manager of Operations.This newly recreated (more...)
Company: Robert Half International
Location: Los Angeles
Posted on: 04/3/2020

Inspections Specialist, ISA - Irvine
Description: Requisition Number 20-0027 Post Date 3/12/2020 Title Inspections Specialist, ISA - Irvine Division Division of Registration and Inspections PT/FT Full Time City Irvine State CA Description Our Mission (more...)
Company: Public Company Accounting Oversight Board, The(PCA
Location: Irvine
Posted on: 04/3/2020

Senior .net developer - Financial Services
Description: Our client is a Los Angeles based global investment firm, one of the leaders in their industry. They are looking for a passionate Senior .net Developer to join their team Who are you
Company: Technical Connections, Inc.
Location: Los Angeles
Posted on: 04/3/2020

Senior Backend Engineer
Description: Job Description: Capital Group is committed to leveraging the latest advances in cloud computing, data engineering, and machine learning to continue our leadership of the investment management industry. (more...)
Company: Capital Group
Location: Los Angeles
Posted on: 04/3/2020

Inspections Specialist (Audit Regulator) - Irvine
Description: Requisition Number 20-0016 Post Date 2/27/2020 Title Inspections Specialist Audit Regulator - Irvine Division Division of Registration and Inspections PT/FT Full Time City Irvine State CA Description (more...)
Company: Public Company Accounting Oversight Board, The(PCA
Location: Irvine
Posted on: 04/3/2020

Corporations Banker, VP / ED
Description: New business development and relationship management for our clientsDevelopment of forward looking business plans for clients and the maintenance of existing business relationshipsConducting comprehensive (more...)
Company: JPMorgan Chase & Co
Location: Los Angeles
Posted on: 04/3/2020

Frontend Engineer / ReactJS / Financial Product / $145,000
Description: A quickly growing software product company in Hollywood is seeking to add a Frontend ReactJS engineer to their small engineering team. With a cutting edge product in the financial space, this company (more...)
Company: Motion Recruitment
Location: Los Angeles
Posted on: 04/3/2020

Log In or Create An Account

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

Hacienda Heights RSS job feeds