What are the responsibilities and job description for the Auditor, Payment Integrity position at Independence Blue Cross and Careers?
Our organization is looking to diversify, grow, innovate, and serve, and we are looking for committed, empowered, learning-oriented people to join our team. If this describes you, we want to speak with you.
The Payment Integrity Auditor is responsible for conducting complex and high-risk audit assignments to ensure claim payment accuracy and compliance with established billing and coding parameters. This role applies advanced audit methodologies to identify claim overpayments, validate payment integrity, and support organizational goals through detailed analysis and provider engagement.
Responsibilities:
- Address problematic and complex audit assignments to identify claim overpayments in accordance with established billing and coding parameters.
- Identify payment methods and factors used in reimbursing targeted claims and apply appropriate audit/payment accuracy methods.
- Evaluate and audit samples in summary and in detail to select audit claims.
- Examine medical and billing records to identify provider patterns that determine or influence payment.
- Interact with providers to clarify clinical issues, documentation, and billing practices.
- Document and substantiate billing discrepancies to providers and negotiate resolution when appropriate.
- Initiate and verify claim adjustments, maintain audit documentation, and prepare statistical data.
- Serve as vendor claims processing lead, liaison, or point of contact to ensure achievement of vendor work.
Qualifications:
Education:
o Bachelor’s degree or equivalent.
Certifications (Preferred, Not Required):
Registered Health Information Administrator (RHIA)
Registered Records Administrator (RRA)
Certified Coding Specialist – Physician/Hospital (CCS / CCS-P / CCS-H)
Accredited Record Technician (ART)
Certified Professional Coder (CPC)
Certified OR Technician (CORT)
Registered Nurse (RN)
Experience:
o Minimum 3 years of relevant experience in healthcare auditing, coding, or compliance.
Knowledge & Skills:
- Working knowledge of healthcare provider audit methods and provider payment methodologies.
- Understanding of clinical aspects of patient care, medical terminology, and medical record/billing documentation.
- Demonstrated analytical and investigative skills.
- Strong proficiency in MS Excel and audit tools.
- Excellent communication and negotiation abilities.
Fully Remote:
This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence’s physical office locations to perform the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.