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Clinical Medical Records Auditor

  • Job Family: QLT > Analysis
  • Type: Full time
  • Date Posted:
  • Anticipated End Date:
  • Reference: JR117837





Clinical Medical Records Auditor

A proud member of the Elevance Health family of companies, Paragon Healthcare brings over 20 years in providing life-saving and life-giving infusible and injectable drug therapies through our specialty pharmacies, our infusion centers, and the home setting.

Location: Plano, Texas

The Clinical Medical Records Auditor is responsible for the audit and review of medical record documentation for the support of claim payments.

How You Will Make an Impact

Primary duties may include, but are not limited to:

  • Audits provider claims for compliance to standard coding and billing practice guidelines.

  • Reviews the Radiology Interpretive Report as a supporting document for CPT-4 and ICD-9 codes billed.

  • Identifies providers where upcoding and unbundling of CPT-4 codes is suspect.

  • Reports on findings.

  • Assists the Director of HIM in the development of infusion specific coding edits.

  • Reviews and renders decisions on appeals to claim clinical coding denials for improper coding or lack of preauthorization.

  • Serves as resource and subject matter expert on clinical coding to internal and external customers.

Minimum Requirements:

A.S degree in related field; a minimum of 5 years of experience in ICD-9 and CPT-4 coding; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

  • Minimum 1 year experience with procedural coding and billing strongly preferred.

  • Minimum 1 year experience of clinical experience in Infusion centers/ home infusion.

  • Minimum 1 year experience of reviewing medical documentation/ auditing experience


Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local 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 job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.

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