Clinical Provider Auditor II
About the Role
This position enables associates to work virtually full‑time, with required in‑person training sessions to support productivity, work‑life integration, and essential onboarding and skill development. The Clinical Provider Auditor II is responsible for identifying issues and entities that may pose potential risk associated with fraud and abuse.
Responsibilities
- Examine claims for compliance with billing and processing guidelines and identify opportunities for fraud and abuse prevention and control.
- Review and analyze claims and medical records prior to payment, using required systems/tools to accurately document determinations and advance the claims lifecycle.
- Research new healthcare‑related questions to aid investigations and stay current on medical coding, billing issues, trends, and regulatory changes.
- Collaborate with the Special Investigation Unit and other internal areas on matters of mutual concern.
- Recommend interventions for loss control and risk avoidance based on investigation outcomes.
- Assist with training of new associates.
Minimum Requirements
- Associate’s degree (AA/AS) or equivalent.
- Minimum of 3 years medical coding/auditing experience, including at least 1 year focused on fraud, waste, or abuse.
- Required coding certification (CPC, CCS, or CPMA).
Preferred Skills and Qualifications
- Knowledge of ICD‑10 and CPT/HCPC coding guidelines and terminology.
Salary
For candidates working in person or virtually in Virginia, the salary range for this position is $55,480 to $100,740. Compensation is determined by factors such as geographic location, work experience, education, skill level, and market considerations.
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase plan
- 401(k) contribution with match
- Merit increases
- Paid holidays and Paid Time Off
- Incentive bonus programs (where applicable)
- Medical, dental, and vision insurance
- Short‑ and long‑term disability coverage
- Life insurance
- Wellness programs
- Financial education resources
Location
The role is based in Virginia and is primarily virtual, with required in‑person training sessions. Alternate locations may be considered for candidates who reside within a reasonable commuting distance from an Elevance Health office. Candidates outside of this range will not be considered unless accommodation is required by law.
About Elevance Health
Elevance Health is a Fortune 25 health company dedicated to improving lives and communities while simplifying healthcare. The organization values a culture that advances strategy, supports personal and professional growth, and drives shared success for members, associates, and communities.
Work Environment
Elevance Health operates under a Hybrid Workforce Strategy. Unless specified as primarily virtual, associates are expected to work on‑site at least once per week, with specific onsite requirements discussed during the hiring process.