Arizona Licensed Program Integrity Auditor

Job Summary

Arizona Licensed Program Integrity Auditor is a full-time position responsible for reviewing medical records to ensure compliance with coding and documentation standards, while also identifying potential fraud, waste, or abuse.

Key Responsibilities

• Conduct routine and ad hoc audits of provider records across multiple lines of business to ensure compliance with regulatory standards
• Identify and report aberrant billing patterns and potential fraud, waste, or abuse to internal staff and assist in investigations
• Provide technical assistance and education to providers regarding regulatory requirements and coding rules

Required Qualifications

• 3-5 years of experience in reviewing claims data and medical records
• 3-5 years of experience with industry coding guidelines such as CPT, HCPCs, and ICD-10
• Active CPC, CCS, or CPMA license required
• Willingness to work Monday-Friday from 8am-5pm Arizona Time Zone
• Associate's degree or equivalent experience (2+ years of relevant experience + high school diploma or GED)