Clinical Provider Auditor Lead - Maryland Behavioral Health

• Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.
  

• Leads day-to-day activities of the audit team, providing allocation of resources, establishing priorities, and serving as resource to lower-leveled audit associates.
  
• Manages vendor relationships with contracted vendors.
  
• Periodically audits work of vendors and ensures that terms of contract are being satisfied.
  
• Conducts provider meetings to discuss audit findings and appeals for most complex audits.
  
• Negotiates settlements.
  
• Researches claims payment methodologies and fee schedule pricing of claims.
  
• Adjusts and re-prices claims per audit findings.
  
• Assists in resolving contractual issues with providers and in reviewing audit process, policy and procedures.
  
• Prepares and analyzes various reports to demonstrate recoveries and potential issues with providers.
  
• Assists manager with reimbursement/audit initiatives as identified.
  
• Supports enterprise initiatives and develops educational materials for internal staff and providers.
  

• Requires a BA/BS and minimum of 5 years experience in a related field, which could include provider audit, reimbursement; or any combination of education and experience, which would provide an equivalent background.
  

• Experience related to medical coding, including coding certification and a clinical background, project management and leadership experience strongly preferred.
  
• Behavioral Health coding and auditing experience preferred.
  
• Coding certification (CPC, CCS, CPMA) preferred.
  

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact View email address on aplitrak.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act