Arizona Licensed Program Integrity Auditor

Job Summary

Responsible for auditing healthcare provider records, the full-time Arizona Licensed Program Integrity Auditor will review medical documentation for coding accuracy, identify potential fraud, waste, or abuse, and provide education to providers while working remotely.

Key responsibilities

• Conduct routine and ad hoc audits of provider records to ensure compliance with coding and documentation standards
• Identify aberrant billing patterns and report potential fraud, waste, or abuse to internal staff and state regulators
• Provide technical assistance and education to healthcare 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
• 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)