Anthem, Inc. Provider Auditor Sr in Houston, Texas
SHIFT: Day Job
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re 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 care companies and a Fortune Top 50 Company.
Duties & Responsibilities
Provider Auditor Sr
Primary duties may include, but are not limited to:
• Conducts on-site 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. • Selects providers to be reviewed based on historical results of other reviews with providers, network management input and dollar volume of provider. • Schedules review with provider, analyzes data to select claims to be reviewed, conducts review using medical charts, medical notes, itemized bills and provider contracts. • Conducts exit interview with provider management team by presenting preliminary review results. • Verifies dollar amount on claim is correct in claims system and writes report of the findings of the review and requests payments for any overpayments. • 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.
The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against Covid-19. All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.
Minimum requirements • Requires either a BA/BS degree, medical coding certification and a minimum of 3 years equivalent work experience; or any combination of education and experience, which would provide an equivalent background.
Preferred requirements • RN or medical coding certification strongly preferred.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.