United States onlyProvidence Health Plan caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Providence Health Plan is calling a Senior Pre-Payment External Auditor, Finance who will:
- Support the compliance related activities of the Special Investigations Unit (SIU) at the Health Plan
- Develop, implement and perform compliance related pre-payment auditing and monitoring activities at the Health Plan
- Including but not limited to:
- Identification, investigation and correction of fraudulent and/or abusive billing and coding practices
- Coordination of pre-payment chart abstraction prior to benefit application and recovery of overpayments related to fraudulent and/or abusive billing and coding practices
- Detailed tracking of prepay audit operations (ie. live claims queue, SIU claims workflow, claims review history) and audit documentation
- Including but not limited to:
- Provide customer service support and education related to coding, medical record documentation requirements, healthcare compliance and fraud, waste and abuse to Health Plan staff, vendors members, and contracted providers/facilities
- Attain and maintain a Certified Professional Coding credential with the American Academy of Professional Coders
- Regularly educate themselves through various means of the changes to both healthcare medical coding and fraud waste and abuse investigation techniques
- Manage a high volume of complex varied fraud case workloads and if necessary support external law enforcement and legal counsel
We welcome 100% remote work for residents who reside in one of the following States:
- Oregon
- Washington
- California
Required qualifications for this position include:
- Bachelor's Degree - OR- a combination of equivalent education and experience
- 5+ years of coding experience with a healthcare provider, facility or health insurance company
- Project Management Experience
- Education Program Development Experience
- Group Presentation Experience
- Experience in use of data mining software / tools
Preferred qualifications for this position include:
- Professional communication, including significant writing, for management presentations and provider education
- Able to synthesize risk information and research in an efficient and effective manner
- Current certification as an Accredited Healthcare Fraud Investigator (i.e., AHFI, CFI)
- Certification as an Internal Auditor (i.e., CPMA, CHCA) or Healthcare Compliance (CHC) certification
- Clinical Background (Examples: MD, NP/PA, RN, DC)
- Certified Internal Auditor (CIA)
- Certification in Project Management (examples: PMP, CSM, Six Sigma)
Why Join Providence?
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Check out our benefits page for more information about our Benefits and Rewards.
