LTSS Provider Auditor

3 weeks ago


Indianapolis, United States Elevance Health Full time

Location: Indianapolis, IN

Hours: M – F

Travel: Field Based Role (25% - 50% in state travel)

Position Overview:

The LTSS Provider Auditor is a part of the LTSS PR team, supporting quality in service delivery. The LTSS Provider Auditor is responsible for quality oversight and ensuring LTSS Providers are in compliance with federal state laws, and internal policies related to LTSS/HCBS service delivery.

How You Will Make an Impact:

  • Leads day-to-day activities related to LTSS provider performance and compliance monitoring, ensuring adherence to contractual and federal requirements specific to HCBS providers.

  • Operates as the Subject Matter Expert as it pertains to LTSS provider compliance requirements and oversight and LTSS Benefits.

  • Working in alignment with the LTSS PR Rep, conducts audits and onsite reviews supporting contractual requirements.

  • Reviews policies and procedures to support contractual compliance for provider programs.

  • Conducts provider meetings to discuss audit findings and review action plans to ensure providers can come into compliance with health plan expectations, contractual and federal requirements.

  • Selects providers to be reviewed based on historical results of other reviews with providers, network management input and dollar volume of provider

  • Schedules review with provider, analyzes data to select claims to be reviewed, conducts review using medical charts, medical notes, itemized bills and provider contracts

  • Conducts exit interview with provider management team by presenting preliminary review results

  • Verifies dollar amount on claim is correct in claims system and writes report of the findings of the review and requests payments for any overpayments

  • Identifies aberrant patterns of billing and detects potential abuse

  • Participates in developing and/or reviewing department policies and procedures

  • Works on task forces and committees

Required Qualifications:

  • Requires either a BA/BS degree, medical coding certification and a minimum of 2 years’ relevant work experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications:

  • Experience coordinating projects preferred

  • Provider Quality oversight experience preferred

  • Experience with MS Office, particularly PowerPoint and Excel

  • Strong Medicaid LTSS experience

  • Knowledge of state and federal requirements impacting LTSS providers, including but not limited to Person Centered Planning, HCBS Settings Rule, Electronic Visit Verification.

  • Experience with home health, personal care, hospice, nursing facilities, and/or assisted living providers preferred



  • Indianapolis, United States DaMar Staffing Full time

    Job Description Company Information: A healthcare company with corporate office located in Indianapolis Metro area, serving more than 100 million people at every stage of health. Location:This position is primarily remote. Candidates must have an appropriate home workspace and be available for occasional in-person team meetings. Job Summary: The LTSS...


  • Indianapolis, United States DaMar Staffing Full time

    Job Description Company Information: A healthcare company with corporate office located in Indianapolis Metro area, serving more than 100 million people at every stage of health. Location:This position is primarily remote. Candidates must have an appropriate home workspace and be available for occasional in-person team meetings. Job Summary: The LTSS...


  • Indianapolis, United States CareBridge Health Full time

    Job DescriptionJob DescriptionLTSS Specialist--IndianaThe CareBridge Long Term Services and Supports (LTSS) Specialist collaborates with Managed Care Organizations to support persons aging in place receiving home and community based services. The LTSS Specialist performs telephonic and/or virtual assessments to identify participants' needs including...


  • Indianapolis, United States Elevance Health Full time

    Job Description : LTSS Service Coordinator - RN Clinician Location: Nashville, TN and/or Davison County, TN This is a field position 4-5 days per week $1,250 Sign On Bonus The LTSS Service Coordinator - RN Clinician is responsible for overall management of member's case within the scope of licensure; provides supervision and direction to...


  • Indianapolis, United States Professional Management Enterprises Full time

    Job DescriptionJob DescriptionDescription:Location: Indiana, USACompany: BKG EnterprisesAbout Us: BKG Enterprises is a leading healthcare organization committed to providing comprehensive care coordination services to our members. We are dedicated to optimizing member healthcare across the care continuum, ensuring individuals with chronic illnesses,...


  • Indianapolis, United States Elevance Health Full time

    Job Description : Location: Field associates spend 4-5 days per week in-person with patients, members or providers. The LTSS SERVICE COORDINATOR – RN CLINICIAN is responsible for overall management of member's case within the scope of licensure; provides supervision and direction to non-RN clinicians participating in the member's case in...

  • Night Auditor

    5 days ago


    Indianapolis, United States Holiday Inn Airport Indianapolis, IN Full time

    Job Title: Hotel Night Auditor Company: Holiday Inn Indianapolis Airport Top Places to Work 3 Years Running At Holiday Inn Indianapolis Airport, we believe in the power of exceptional service and creating memorable experiences for our guests. We have been recognized as a top workplace for three consecutive years, a testament to our commitment to excellence...

  • Night Auditor

    3 days ago


    Indianapolis, United States Holiday Inn Airport Indianapolis, IN Full time

    Job DescriptionJob DescriptionJob Title: Hotel Night AuditorCompany: Holiday Inn Indianapolis AirportTop Places to Work 3 Years RunningAt Holiday Inn Indianapolis Airport, we believe in the power of exceptional service and creating memorable experiences for our guests. We have been recognized as a top workplace for three consecutive years, a testament to our...


  • Indianapolis, United States Creative Financial Staffing Full time

    Job Title: Internal Operations Auditor Location: Plainfield, IN Job Description: We are seeking a diligent and detail-oriented Internal Operations Auditor to join our team. As an Internal Operations Auditor, you will play a critical role in assessing and improving the efficiency and effectiveness of our internal processes and procedures. This position...


  • Indianapolis, United States Creative Financial Staffing Full time

    Job Title: Internal Operations Auditor Location: Plainfield, IN Job Description: We are seeking a diligent and detail-oriented Internal Operations Auditor to join our team. As an Internal Operations Auditor, you will play a critical role in assessing and improving the efficiency and effectiveness of our internal processes and procedures. This position...

  • Night Auditor

    5 days ago


    Indianapolis, United States The Alexander | a Dolce Hotel Full time

    Property Description The Alexander, A Dolce Hotel is a contemporary and upscale hotel located in the vibrant city of Indianapolis, Indiana, offering an exciting and dynamic work environment. As a job applicant, joining the team at The Alexander means being part of a distinctive hotel known for its modern design, exceptional service, and prime location in the...

  • Night Auditor

    2 hours ago


    Indianapolis, United States The Alexander | a Dolce Hotel Full time

    Property Description: The Alexander, A Dolce Hotel is a contemporary and upscale hotel located in the vibrant city of Indianapolis, Indiana, offering an exciting and dynamic work environment. As a job applicant, joining the team at The Alexander means being part of a distinctive hotel known for its modern design, exceptional service, and prime location in...

  • Training Specialist

    4 weeks ago


    Indianapolis, Indiana, United States Marian University Full time

    As a part of a diverse community of faculty and staff who represent many faith systems and worldviews, Marian University seeks a Training Specialist to promote our Catholic Franciscan mission and identity by supporting the LTSS in coaching and training school-based instructional coaches and provide support for professional development for the Literacy Cadre...

  • Service Coordinator

    1 week ago


    Indianapolis, United States Elevance Health, Inc. Full time

    Location: Field associates spend 4-5 days per week in-person with patients, members or providers. The LTSS SERVICE COORDINATOR is responsible for conducting service coordination functions for a defined caseload of individuals in the IN PathWays for Aging program. In collaboration with the person supported, facilitates the Person Centered Planning process...

  • Service Coordinator

    1 week ago


    Indianapolis, United States Elevance Health, Inc. Full time

    Location: Field associates spend 4-5 days per week in-person with patients, members or providers. The LTSS SERVICE COORDINATOR is responsible for conducting service coordination functions for a defined caseload of individuals in the IN PathWays for Aging program. In collaboration with the person supported, facilitates the Person Centered Planning process...

  • Care Coordinator

    1 week ago


    Indianapolis, United States Elevance Health, Inc. Full time

    Location: Field associates spend 4-5 days per week in-person with patients, members or providers. The LTSS SERVICE COORDINATOR - CLINICIAN is working under the direction/supervision of an RN, with overall responsibility for the member's case, as required by the IN PathWays for Aging program, contributes to the LTSS care coordination process by performing...

  • Night Auditor

    5 days ago


    Indianapolis, United States Aimbridge Hospitality Full time

    Job Summary The Night Auditor is responsible for the preparation and disposition of all Night Audit work. Responsible for the front desk operation during the overnight shift (Typically 11pm-7am). Primary responsibilities include: registering guests making reservations preparing daily reports balancing transactions and conducting security...

  • Staff Auditor

    5 days ago


    Indianapolis, United States DMC Insurance Inc. Full time

    Job DescriptionJob DescriptionWe are seeking a highly motivated and detail-oriented individual to join our team as a Staff Auditor. In this role, you will be responsible for conducting audits of financial records and processes to ensure compliance with regulatory requirements and internal policies. You will work closely with our finance and accounting team...


  • Indianapolis, United States State of Indiana Full time

    Full job description Work for Indiana Begin a fulfilling career with the State of Indiana by joining one of the largest employers in the state, offering a diverse range of opportunities across 60+ agencies. At the state, you'll find competitive compensation, a robust benefits package and a commitment to work-life balance. Most importantly, you'll have the...


  • Indianapolis, United States Russell Tobin Full time

    Job DescriptionJob DescriptionOur client, one of the largest healthcare corporations, is looking for Healthcare Insurance Sales Call Auditor within the Medicare and health insurance sectors to join their team remotely. The ideal candidate will have a deep understanding of sales call auditing, sales processes, and compliance with Medicare guidelines and...