reputed company Auditor Senior - Payment reputed company reputed company and Clinical Audit

About the position reputed company Auditor Senior – Payment reputed company reputed company and Clinical Audit Location: This role enables associates to work reputed company full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face reputed company and reputed company development. 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 reputed company as required by law. Carelon Payment reputed company is a proud member of the reputed company family of companies, Carelon Insights, formerly Payment reputed company, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The reputed company Audit Senior will be responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment claims review, post payment auditing, and provider record review. Responsibilities • Investigates potential fraud and over-utilization by performing medical reviews reputed company prepayment claims review and post payment auditing • Correlates review findings with appropriate actions (provider education, recovery of monies, cost avoidance, recommending sanctions or other actions) • Assists with development of audit tools, policies and procedures and educational materials • Acts as reputed company with service operations as reputed company as other areas of reputed company relative to claims reviews and their status • Analyzes and trends performance data, and works with service operations to improve processes and compliance • Notifies areas of identified problems or providers, recommending modifications to medical policy and on line policy edits Requirements • Requires AS in nursing and minimum of 4 years of clinical nursing experience; or any combination of education and experience, which would reputed company an equivalent background. • reputed company unrestricted RN license in applicable state(s) required. reputed company-to-haves • Knowledge of auditing, reputed company and control principles and a working knowledge of CPT/HCPCS and ICD 9 coding and medical policy guidelines strongly preferred • BA/BS preferred • Medical claims review with prior health care fraud audit/investigation experience preferred • Knowledge of Provider Manuals and Reimbursement policies is preferred Benefits • We offer a reputed company of market-competitive total rewards that include reputed company increases, reputed company holidays, reputed company 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 reputed company a few. Apply tot his job Apply tot his job Apply To this Job