Clinical Provider Auditor II
Core
Examines claims for compliance with billing guidelines to identify fraud, waste, and abuse risks in the healthcare sector.
Role type
Mid-level clinical provider auditor (fraud and abuse)
Builds
Fraud prevention controls and loss avoidance recommendations
Domain
Healthcare / Medical Billing & Auditing
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Medical coding, Claims auditing, Fraud investigation, ICD-10, CPT/HCPC coding, Regulatory compliance
Preferred skills
Knowledge of medical coding guidelines and terminology
Technologies
Required systems/tools for claims analysis
Responsibilities
Review and analyze claims and medical records prior to payment, Research healthcare laws and coding trends, Collaborate with Special Investigation Unit, Recommend interventions for loss control, Assist in training new associates
Seniority
Mid-level, hands-on IC
