Aetna
Program Integrity Auditor
Work at Home, Arizona, United States · Staff+ · Full-time
Sponsorship not specified$47k-$122kDetected 72 days ago
AuditingCommunicationCritical ThinkingAdaptability
About the role
- The Program Integrity Auditor is responsible for the review of records for medical, behavioral, transportation, and other healthcare providers.
- Activities include reviews/audits of provider records to ensure appropriate coding standards and documentation standards are being met.
- The Auditor will also be recommending follow-up action including (but not limited to) provider education, recoupment of funds or rebilling of claims, and referral to state regulators for any suspected fraud, waste, or abuse (FWA).
Responsibilities
- Maintain compliance with company policies and procedures.
Requirements
- 3-5 years of experience with standard industry coding guidelines such as CPT, HCPCs, and ICD-10.
Nice to have
- Previous auditing experience.
- Previous experience with QuickBase.
- Strong analytical and critical thinking skills.
- Strong attention to detail.
- Excellent presentational skills.
- Strong communication skills, both written and verbal.
- Our people fuel our future.
- Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful.
Skills
- Assisting with further investigation and/or reports to state regulators through the utilization of developed critical thinking skills.
Compensation
- $46,988.00 - $122,400.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.
- The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.
- This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
- Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Benefits
- We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience.
- At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.
- Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.
- Position Summary The Program Integrity Auditor is responsible for the review of records for medical, behavioral, transportation, and other healthcare providers.
- The Auditor must have the ability to determine correct coding and appropriate documentation during the review of medical records.
Company info
- our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people.
- They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.
This listing is sourced directly from Aetna's careers page and normalized into a canonical job model.