Clinical Provider Auditor II - Payment Integrity SIU
Hybrid · Atlanta, Georgia, United States or Tampa, Florida, United States
Job Summary
Clinical Provider Auditor II – Payment Integrity SIU examines claims for compliance with billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control. Reviews and analyzes claims and medical records prior to payment, documents determinations, researches new healthcare coding questions, and stays current with ICD-10/CPT/HCPCS coding guidelines. Collaborates with the Special Investigation Unit and internal teams, recommends interventions for loss control and risk avoidance, and assists with training of new associates. Role is hybrid with in-office 1-2 days per week; alternate locations considered if commuting distance requirements are met.
Required Qualifications
- AA/AS degree in a related field or equivalent
- Minimum 3 years medical coding/auditing experience
- Minimum 1 year of fraud, waste and abuse experience
- Coding certification (CPC, CCS, CPMA)
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