Clinical Provider Auditor I - Maryland Behavioral Health

Auditor I role focuses on examining claims for compliance with billing and processing guidelines, identifying opportunities for fraud and abuse prevention, reviewing medical records prior to payment, and documenting determinations using required systems. Responsibilities include researching coding questions, staying current on medical coding/billing issues (ICD-10, CPT/HCPC), and collaborating with the Special Investigation Unit and other internal groups to recommend interventions for loss control. Requires an AA/AS and 1 year of related experience, with a CPC/CCS/CPMA certification within one year; field-based with primary work in Maryland, with a hybrid schedule requiring weekly onsite presence at Elevance Health locations. Vaccination policy applies for certain patient/member-facing roles; the organization emphasizes equal opportunity employment.