Payment Integrity Auditor I

Premera Blue Cross is dedicated to improving healthcare for its customers, and they are seeking a Payment Integrity Auditor I. In this role, you will conduct audits to ensure coding accuracy and compliance while collaborating with various internal teams.

Responsibilities

• Conduct entry-level audits of professional and facility claims to ensure coding accuracy and compliance with contractual, coding, payment policy, and regulatory standards
• Review itemized bills, medical records, and other claim documentation to verify coding accuracy and appropriateness of charges
• Validate coding accuracy for CPT, HCPCS, ICD-10-CM, and DRG
• Identify and report coding discrepancies or errors and recommend adjustments where appropriate
• Identify opportunities for fraud, waste, and abuse prevention and control
• Maintain accurate and detailed records of audit findings and outcomes for reporting purposes
• Collaborate with internal teams (e.g., claims processing, provider relations, special investigations unit)
• Utilize auditing software and systems to document, track, and analyze claims data
• Stay updated on coding guidelines, payer policies, and industry standards, including CMS regulations
• Participate in ongoing training and development to enhance coding and auditing skills
• Support Payment Integrity team initiatives by contributing to process improvement efforts and team goals

Skills

• Bachelor's Degree or equivalent combination of education and experience
• (1) year of related medical coding or auditing experience
• Certified Professional Coder Designation (CPC-A, CPC, CSS, CPMA) or equivalent
• Knowledge of health plan operations and claim adjudication processes
• Experience with facility, professional, and ancillary coding
• Familiarity with auditing software tools

Benefits

• Medical, vision, and dental coverage with low employee premiums.
• Voluntary benefit offerings, including pet insurance for paw parents.
• Life and disability insurance.
• Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.
• Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.
• Generous paid time off to reenergize.
• Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.
• Employee recognition program to celebrate anniversaries, team accomplishments, and more.
• Commuter perks make your trip to work less impactful on the environment and your wallet.
• Free convenient on-site parking.
• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
• Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.

Company Overview

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