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Clinical Provider Auditor II
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$58,800 - $105,840 a year
Full-time
- Location: The ideal candidate will live within 50 miles of one of our pulse point locations and will work on a hybrid work model (1-2 days per week in the office).
- The Clinical Provider Auditor is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse.
- Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to accurately document determinations and continue to the next step in the claim’s lifecycle.
- Research new healthcare-related questions as necessary to aid in investigations and stay abreast of current medical coding and billing issues, trends, and changes in laws/regulations.
- Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation.
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