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Company | Elevance Health |
Address | United States |
Employment type | FULL_TIME |
Salary | |
Category | Hospitals and Health Care |
Expires | 2023-08-29 |
Posted at | 9 months ago |
- Type: Full time
- Job Family: Enterprise Operations
- Req #: JR65618
- Date Posted:Jul 26, 2023
- GA, ATLANTA
- IN, INDIANAPOLIS
- National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
- VA, RICHMOND
- May interface internally with Senior level management and legal department throughout investigative process.
- Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims.
- May assist in training of internal and external entities. Assists in the development of policy and/or procedures to prevent loss of company assets.
- Effectively establish rapport and on-going working relationship with law enforcement.
- Responsible for identifying and developing enterprise-wide specific healthcare investigations that may impact more than one company health plan, line of business and/or state.
- Requires a BA/BS and minimum of 3 years related experience; or any combination of education and experience, which would provide an equivalent background.
- Claims systems experience is a plus.
- Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred.
- Advanced Excel skills highly preferred.
- Fraud certification from CFE, AHFI, AAPC or coding certificates preferred.
- 2+ years of healthcare fraud investigation experience preferred.
- 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.
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