RN Hospital Bill Audit/Appeal Lead
Company: Elevance Health
Location: Atlanta
Posted on: October 5, 2024
Job Description:
Supports the Carelon Payment Integrity line of businessLocation:
This position will work a hybrid model (remote and office). The
ideal candidate will live within 50 miles from our Elevance Health
Pulse Point locations.Carelon Payment Integrity is a proud member
of the Elevance Health family of companies, Carelon Insights,
formerly Payment Integrity, is determined to recover, eliminate and
prevent unnecessary medical-expense spending.The RN Hospital
Audit/Appeal Lead is responsible for leading a team of clinicians
responsible for identifying, monitoring, and analyzing aberrant
patterns of utilization and/or fraudulent activities by health care
providers through prepayment claims review, post payment auditing,
and provider record review.How You Will Make An Impact
- Develops, maintains and enhances the claims review
process.
- Assists management with developing unit goals, policies and
procedures.
- Investigates potential fraud and over-utilization by performing
the most complex medical reviews via prepayment claims review and
post payment auditing.
- Correlates review findings with appropriate actions (provider
education, recovery of monies, cost avoidance, recommending
sanctions or other actions.
- Acts as principal liaison with Service Operations as well as
other areas of the corporation relative to claims reviews and their
status.
- Notifies areas of identified problems or providers,
recommending modifications to medical policy, on line policy
edits.
- Trains and provides guidance to nurse auditors and manages
workflow and priorities for the unit.Minimum Requirements
- Requires AS in nursing and minimum of 5 years of clinical
experience and minimum of 2 years of claims review experience; or
any combination of education and experience, which would provide an
equivalent background.
- Current unrestricted RN license in applicable state(s)
required.
- Travels to worksite and other locations as necessary.Preferred
Qualifications, Skills & Capabilities
- BA/BS preferred.
- Knowledge of auditing, accounting and control principals and
working knowledge of CPT/HCPCS and ICD 10 coding and medical policy
guidelines strongly preferred.
- Certification as a Professional Coder preferred.
- Hospital Bill Audit Experience preferred.
- Itemized Bill Review Experience preferred.
- Hospital Bill Audit/Itemized Bill Review Appeal Experience
preferred.For candidates working in person or remotely in the below
locations, the salary* range for this specific position is $83,412
to $142,992.Locations: District of Columbia (Washington, DC);
Maryland; New York.In addition to your salary, Elevance Health
offers benefits such as, a comprehensive benefits package,
incentive and recognition programs, equity stock purchase and 401k
contribution (all benefits are subject to eligibility
requirements). The salary offered for this specific position is
based on a number of legitimate, non-discriminatory factors set by
the company.The company is fully committed to ensuring equal pay
opportunities for equal work regardless of gender, race, or any
other category protected by federal, state, and local pay equity
laws .
- The salary range is the range Elevance Health in good faith
believes is the range of possible compensation for this role at the
time of this posting. This range may be modified in the future and
actual compensation may vary from posting based on geographic
location, work experience, education and/or skill level. Even
within the range, the actual compensation will vary depending on
the above factors as well as market/business considerations. No
amount is considered to be wages or compensation until such amount
is earned, vested, and determinable under the terms and conditions
of the applicable policies and plans. The amount and availability
of any bonus, commission, benefits, or any other form of
compensation and benefits that are allocable to a particular
employee remains in the Company's sole discretion unless and until
paid and may be modified at the Company's sole discretion,
consistent with the law.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 AreElevance 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 WorkAt
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. Candidates must reside within 50 miles or 1-hour
commute each way of a relevant Elevance Health location.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.
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 elevancehealthjobssupport@elevancehealth.com
for assistance.
Keywords: Elevance Health, Athens , RN Hospital Bill Audit/Appeal Lead, Accounting, Auditing , Atlanta, Georgia
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