Auditor, Payment Integrity Specialist

4 weeks ago


Philadelphia, Pennsylvania, United States Independence Blue Cross Full time

We are seeking a skilled Auditor, Payment Integrity Specialist to join our team at Independence Blue Cross. As a key member of our organization, you will play a critical role in ensuring the accuracy of provider payments and charges.

The ideal candidate will have a strong background in healthcare provider audit methods and medical terminology, with the ability to analyze and investigate claims for fraud, waste, or abuse. Additionally, they will possess excellent analytical skills, interviewing and investigative skills, and working knowledge of MS Office, Excel, Word, Outlook, SharePoint, and Access.

As a Hybrid model employee, you will work in the office three days a week and remotely two days a week, with the flexibility to work from the Tri-State Area of Delaware, New Jersey, or Pennsylvania. We offer a dynamic and innovative work environment, with opportunities for professional growth and development.

Responsibilities include:

  • Identifying patterns of provider billing for fraud, waste, or abuse
  • Auditing claims to verify accuracy of provider payments and charges
  • Analyzing and verifying provider billing, with a focus on desk reviews and medical billing records
  • Addressing provider audit assignments to identify patterns of abuse or fraud
  • Screening and auditing claims to select samples for audit, and initiating and verifying claim adjustments
  • Identifying and referring potential provider fraud or abuse to management
  • Providing work guidance to lower-level Provider Auditors

Qualifications include:

  • Certified Pharmacy Technician (CPhT) required
  • Four or more years of experience in healthcare provider audit, with two or more years of experience in healthcare claims or customer service
  • Extensive knowledge of healthcare provider audit methods and medical terminology
  • Demonstrated analytical skills, interviewing and investigative skills
  • Working knowledge of MS Office, Excel, Word, Outlook, SharePoint, and Access

We are an Equal Opportunity and Affirmative Action Employer, and all qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.



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