lpollick
New
Independence Blue Cross is seeking candidates for a full-time Provider Auditor based out Center City, Philadelphia. The Provider Auditor is responsible for the following:
? Identify payment method and factors used in reimbursing targeted claims and apply appropriate audit methods.
? Screen and audit samples in summary and in detail to select claims for audit.
? Examine medical and billing records to identify provider patterns that determine or influence payment.
? Interview provider to clarify clinical issues, documentation and billing practices.
? Document and substantiate billing discrepancies to providers and negotiate resolution.
? Initiate and verify claim adjustments, maintain audit documentation, and prepare statistical data.
? Identify and refer potential provider fraud or abuse to management.
? Identify and participate in development and implementation of new audit functions.
? Provide work guidance to lower level Provider Auditors.
REQUIREMENTS
? BA/BS in Business Administration or related discipline or equivalent knowledge acquired by work experience and training , or BS Nursing.
? Registered Health Information Administrator; Registered Records Administrator (RRA); Certified Coding Specialist Physician / Hospital (CCS / CCS-P / CCS-H); Accredited Record Technician (ART); Certified Professional Coder (CPC); Certified OR Technician (CORT); or RN.
? Four (4) or more years experience which includes two (2) or more of health care Provider Audit experience and may include two (2) or more years of health care Claims or Customer Service experience.
? Extensive Knowledge of health care provider audit methods, and provider payment methods, clinical aspects of patient care, medical terminology, and medical record / billing documentation.
? Demonstrated analytical skills and interviewing and investigative skills.
? Working Knowledge of MS Office, e.g. Excel, Word, Outlook, SharePoint, Outlook, Access, etc.
All interested applicants may apply online by visiting our website www.ibx.com/careers and/or clicking on the attached link: http://ibc.hodesiq.com/job_detail.asp?JobID=5126421&user_id. For additional information/questions, please reach out to Angelina Spruel at Angelina.Spruel@ibx.com
? Identify payment method and factors used in reimbursing targeted claims and apply appropriate audit methods.
? Screen and audit samples in summary and in detail to select claims for audit.
? Examine medical and billing records to identify provider patterns that determine or influence payment.
? Interview provider to clarify clinical issues, documentation and billing practices.
? Document and substantiate billing discrepancies to providers and negotiate resolution.
? Initiate and verify claim adjustments, maintain audit documentation, and prepare statistical data.
? Identify and refer potential provider fraud or abuse to management.
? Identify and participate in development and implementation of new audit functions.
? Provide work guidance to lower level Provider Auditors.
REQUIREMENTS
? BA/BS in Business Administration or related discipline or equivalent knowledge acquired by work experience and training , or BS Nursing.
? Registered Health Information Administrator; Registered Records Administrator (RRA); Certified Coding Specialist Physician / Hospital (CCS / CCS-P / CCS-H); Accredited Record Technician (ART); Certified Professional Coder (CPC); Certified OR Technician (CORT); or RN.
? Four (4) or more years experience which includes two (2) or more of health care Provider Audit experience and may include two (2) or more years of health care Claims or Customer Service experience.
? Extensive Knowledge of health care provider audit methods, and provider payment methods, clinical aspects of patient care, medical terminology, and medical record / billing documentation.
? Demonstrated analytical skills and interviewing and investigative skills.
? Working Knowledge of MS Office, e.g. Excel, Word, Outlook, SharePoint, Outlook, Access, etc.
All interested applicants may apply online by visiting our website www.ibx.com/careers and/or clicking on the attached link: http://ibc.hodesiq.com/job_detail.asp?JobID=5126421&user_id. For additional information/questions, please reach out to Angelina Spruel at Angelina.Spruel@ibx.com
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