Clinical Provider Auditor - Maryland Behavioral Health

Clinical Provider Auditor I - Maryland Behavioral Health

Join to apply for the Clinical Provider Auditor I - Maryland Behavioral Health role at Care Bridge.

$58,051.00/yr - $87,076.00/yr

Supports the Payment Integrity line of business.

Location:

Must be located in Maryland. This field‑based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands‑on engagement.

Please note that, per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

• Identify issues and/or entities that may pose potential risk associated with fraud and abuse.
• Examine claims for compliance with relevant billing and processing guidelines and identify opportunities for fraud and abuse prevention and control.
• Review and conduct analysis of claims and medical records prior to payment, and use required systems/tools to accurately document determinations and continue to next step in the claims lifecycle.
• Research new healthcare‑related questions as necessary to aid in investigations and stay abreast of current medical coding and billing issues, trends and changes in laws/regulations.
• Collaborate with the Special Investigation Unit and other internal areas on matters of mutual concern.
• Recommend possible interventions for loss control and risk avoidance based on the outcome of the investigation.

• AA/AS and minimum of 1 year related medical coding/auditing experience; or any combination of education and experience providing an equivalent background.
• Must achieve coding certification (CPC, CCS, CPMA) within 6 months of starting this position.

• Knowledge of ICD‑10 and CPT/HCPC coding guidelines and terminology strongly preferred.
• Behavioral Health coding and auditing experience preferred.

Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contribution (subject to eligibility requirements). The salary offered is based on legitimate, non‑discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Applicants who require accommodation to participate in the application process may contact elevancehealthj for assistance.