Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve as. At Independence, everyone can feel valued, supported, and comfortable to be themselves.
Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
Audit claims submitted to IBC to verify accuracy of provider payments and charges.
Identify patterns of provider billing for fraud, waste, or abuse.
Audits encompass identification of inappropriate billing through daily reviews, live audits, and desk audits.
This function also includes analysis, verification and adjustment of provider billing based primarily on desk reviews or provider medical billing records in close conjunction with CFID audit analysis, auditors, and investigators.
Address the usual and customary Provider Audit assignments to identify patterns of provider abuse or fraud in accordance with sound audit methods and practices.
Screen and audit samples in summary and in detail to select claims for audit. Initiate and verify claim adjustments, maintain audit documentation, and prepare statistical data. Identify and refer potential provider fraud or abuse to management.
Identify and participate in development and implementation of new audit functions.
Provide work guidance to lower-level Provider Auditors.
Certified Pharmacy Technician (CPhT) required.
Certified Pharmacy Tech for Pharmacy Audit.
Four (4) or more years’ experience which includes two (2) or more of health care Provider Audit experience and may include two (2) or more years of health care Claims or Customer Service experience.
Extensive Knowledge of health care provider audit methods and medical terminology. Demonstrated analytical skills, interviewing and investigative skills.
Working Knowledge of MS Office,Excel, Word, Outlook, SharePoint, Outlook, Access, etc.
Independence has implemented a “Hybrid of Choice” model which provides our associates with the flexibility to choose whether to work remotely, work in the office every day, or work in the office on certain days at their discretion. However, management may require our associates to work from Independence’s physical office locations on certain occasions. This role is designated as a role that fits into the “Hybrid of Choice” model. While associates may work remotely, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.
Independence Blue Cross is the leading health insurance organization in southeastern Pennsylvania. For more than 80 years, we have been enhancing the health and well-being of the people and communities we serve. We deliver innovative and competitively priced health care products and services; pioneer new ways to reward doctors, hospitals, and other health care professionals for coordinated, quality care; and support programs and events that promote wellness.