Senior Clinical Provider Auditor - Hybrid Fraud & Payment
The Elevance Health Companies, Inc.
The Elevance Health Companies, Inc. is seeking a Clinical Provider Auditor Senior – Payment Integrity SIU to review claims for compliance with billing and processing guidelines. The role includes collaboration with the Special Investigation Unit and other teams to detect patterns of billing irregularities. The position requires at least 5 years in medical coding/auditing, with 4 years in fraud, waste and abuse, plus a coding certification (CPC/CCS/CPMA). #J-18808-Ljbffr The Elevance Health Companies, Inc.
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Senior Clinical Provider Auditor - Hybrid Fraud & Payment in Atlanta, GA vacancy
- Elevance Health seeks a Clinical Provider Auditor II - Payment Integrity SIU to identify fraud and waste in claims, review medical records and ensure compliance with billing... ...and implementing process improvements within a hybrid in-office schedule. The ideal candidate has 5+...SeniorFraudWork at office
- Clinical Provider Auditor II - Payment Integrity SIU Location This role requires associates... ...note that per our policy on hybrid/virtual work, candidates... ...Clinical Provider Auditor Senior will be responsible for identifying... ...risk associated with fraud and abuse. How you will...SeniorFraudWork at officeLocal area2 days per week1 day per week
- Elevance Health is seeking a Clinical Provider Auditor II - Payment Integrity SIU to review claims for compliance with billing guidelines and identify fraud patterns. The role requires in-office presence 1-2 days weekly with flexibility for commuting distance. You will...SeniorFraudWork at office
- Elevance Health is seeking a Clinical Provider Auditor Senior - Payment Integrity SIU to join our team in a role requiring on-site presence 1-2 days weekly. The role audits claims for compliance, supports fraud prevention, and collaborates with SIU and internal partners...SeniorFraudRemote work
- Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1-2 days per week, fostering collaboration... ...processing guidelines and identifies opportunities for fraud and abuse prevention and control. Reviews and conducts...SeniorFraudWork at officeLocal area2 days per week1 day per week
- Elevance Health is seeking a Pharmacy Auditor to join our Payment Integrity Complex and Clinical Audit team in a hybrid in‑office role. The candidate will review professional and facility claims, focusing on high‑cost drugs, home infusion therapy, renal claims, and DME,...Work at office
- Pharmacy Auditor - Payment Integrity Complex and Clinical Audit Location This role requires associates to be in-office... ...and connectivity, while providing flexibility to support productivity... ...commuting distance from an office. Hybrid Workforce Policy Elevance Health operates...Contract workTemporary workWork at officeLocal area2 days per week1 day per week
- Pharmacy Auditor - Payment Integrity, Complex and Clinical Audit Location: This role requires associates to be in-office 1-2 days per week, with flexibility... ...and that claims are paid correctly per provider contracts and payer reimbursement policies. Analyze...Contract workWork at officeLocal areaDay shift2 days per week1 day per week
- Elevance Health in Georgia is seeking a Clinical Fraud Investigator II to analyze data and perform in-depth investigations of providers, focusing on fraud and abuse detection in... ...including 1 year in fraud investigations. Hybrid work arrangement is offered with some on-...Fraud
- Elevance Health is seeking a Clinical Fraud Investigator II to conduct comprehensive analysis and investigations of provider data, review claims for compliance, and collaborate with... ...Investigation Unit. The role offers hybrid work with 1-2 days onsite and flexibility...FraudRemote job
- Ameris Bank is seeking a Senior Wire Payments Specialist in Atlanta, Georgia. This role involves providing advanced expertise in wire transfer operations, compliance, and fraud prevention. Responsibilities include mentoring junior specialists, managing complex transactions...SeniorFraud
$150.03k - $224.25k
...Director/Associate Director of Clinical Management, the Senior Clinical Study Manager is... ..., external service providers (ESPs), etc.). Responsibilities... ...Regarding Job Recruiting Fraud Scams At Otsuka we take... ...of any kind or for payment of money during the job application...SeniorFraudContract workTemporary workLocal areaFlexible hoursOtsuka America Pharmaceutical Inc.
Atlanta, GA2 days ago- Visa is seeking a Senior Analyst to join their Payment Systems Intelligence team in Atlanta, Georgia. The role... ...focuses on analyzing cybercrime and fraud activities targeting the global... ...analyst will engage in investigations, provide intelligence reports, and support relationships...SeniorFraud
$80k - $150k
...Contact Government Services) is seeking a Senior Auditor who will assist district legal staff by... ...business financial records to identify payments and kickbacks, trace money flows, identify... ...consulting, and/or health care fraud analysis The resume must demonstrate experience...SeniorFraudFull timeFlexible hoursCGS Federal (Contact Government Services)
Atlanta, GA3 days ago- As a Senior Payments Operations Analyst , this role is accountable for the stability, scalability... ...decision‑making. What You'll Do Provide oversight and quality control for high value... ...Analyze chargeback ratios, trends, and fraud indicators to provide strategic insights...SeniorFraudLocal area
- Elevance Health is seeking a Pharmacy Auditor - Payment Integrity to join our team in Atlanta. You will audit high-cost drug, HIT, DME, ensuring... ...experience and an active pharmacist license. This is a hybrid in-office role with opportunities to impact process improvements...Work at office
- ...Senior Auditor Employment Type: Full Time, Mid-level CGS is seeking a Senior Auditor who... ...records for purposes to include identifying payments and kickbacks, tracing money flows,... ...litigation consulting, and/or health care fraud analysis required. The resume must demonstrate...SeniorFraudFull timeRemote workFlexible hours
Contact Government Services LLC
Atlanta, GA4 days ago - Senior Auditor Generalist Auditing and Advisory Services Georgia State University is seeking an... ...through concise progress updates. Provide credible actionable recommendations and... ...Certified Internal Auditor and/or Certified Fraud Examiner). Preferred Hiring Qualifications...SeniorFraudWork at office
$82.23k - $155.81k
...Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR... ...-person training sessions, providing maximum flexibility and... ...note that per our policy on hybrid/virtual work, candidates not... ...medical claims billing and payment systems, provider billing guidelines...Full timeWork at officeLocal area- Atlanta - Brookhaven The Senior Internal Auditor is responsible for ensuring the integrity of our internal... ...the root cause of issues, and provide actionable, practical recommendations.... ...Internal Auditor) and/or CFE (Certified Fraud Examiner). In‑depth knowledge of GAAP...SeniorFraud
$75k - $95k
...Senior Auditor - Hybrid To Apply Now - email your resume to [email protected] Who: Ideal for audit professionals with approximately 3-5 years of experience. What: Lead audit fieldwork and contribute to nonprofit audit engagements. When: Actively hiring...SeniorWork at officeLocal areaRemote workNorthPoint Search Group Inc
Atlanta, GA11 hours ago- ...based in Atlanta, GA, is searching for a Senior Technical Product Manager - Data to manage... ...stakeholders across functions like Fraud and Finance. The ideal candidate should have... ...of data modeling and ETL processes. This hybrid role offers flexibility and a range of benefits...SeniorFraudFlexible hours
- Who are we? Optimized Payments is the only fintech firm purpose-built... ...motivated and experienced Senior Payments Data Optimization Analyst... ..., etc. While this is a hybrid position based in Atlanta, you... ...impact, routing performance, fraud indicators). Develop data-driven...SeniorFraudLocal areaRemote workWork from home3 days per week
- Position Title: Sr Internal Auditor- Operational Audit (P3) Full job... ...Castle is the nation’s largest provider of shared communications... ...compliance experience a plus. Fraud investigation experience a plus... ...Conditions This role falls into our hybrid work model working in the...SeniorFraudFor contractorsWork at officeWork from homeMonday to Thursday
- BrightSpring Health Services in Atlanta, GA, is seeking a Clinical Record Auditor responsible for conducting comprehensive assessments of home health clinical records. This role ensures that documentation requirements are met, and identifies opportunities for performance...SeniorLocal area
- ...client programs and delivering high-quality analytics services for fraud detection and compliance. Ideal candidates will have at least 8... ...knowledge of financial crime compliance. This position offers a hybrid working model with a focus on teamwork and innovation. #J-18808-...SeniorFraudRemote job
$116.88k - $148.13k
The Role As a Senior Consultant, you will work on strategic programs... ...across geographies. Expert in payment lifecycle. Experience with... ...rules + data requirements for fraud, AML, sanctions, risk scoring,... ...to apply. Infosys is unable to provide immigration sponsorship for this...SeniorFraudTemporary workImmediate start- ...purpose and how you can bring it to life as an Ameris Bank teammate. Job Summary The Senior Wire Payments Specialist provides advanced expertise in wire transfer operations, compliance, and fraud prevention. Acts as a mentor to junior specialists and leads complex projects...SeniorFraudWork experience placementWork at officeFlexible hours
- Clinical Fraud Investigator II Location: Office 1‑2 days per week with... ...within commuting distance. Hybrid policy applies; candidates outside... ...on identified providers as warranted. Examine claims... ...and medical records prior to payment. Research new healthcare‑related...FraudWork at officeLocal areaRemote work2 days per week1 day per week
$121k - $182k
BigCommerce Pty is seeking a Senior Product Manager to drive the Payments & Financial Services portfolio. This role will lead cross-team initiatives, focusing... ...experience, particularly in payments. This is a hybrid position based in Atlanta, GA, where you’ll collaborate...Senior
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Senior Clinical Provider Auditor - Hybrid Fraud & Payment. Be the first to apply!
Related searches