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Elevance Health
Indianapolis
**Location: Indianapolis, IN** **Hours: Standard M - F** **Travel:** **Hybrid (1-2 days in office per week) – Travels to worksite and other locations as necessary.** **Position Overview:** LTSS Claims Educators who are in Indiana and facilitate the exchange of information between the grievances, claims processing, and provider relations systems. Th
Job Source: Elevance HealthElevance Health
Indianapolis
**Location: Indianapolis, IN, Tampa FL, Grand Prairie TX, Nashville TN, Richmond VA** **Hours: M – F Standard Working hours** **Travel:** **Hybrid (1-2 days onsite per week)** **Position Overview:** The Manager II of GBD Special Programs is responsible for management and oversight of multi state program operations and will support the overall strat
Job Source: Elevance HealthDaMar Staffing
Indianapolis, IN, United States
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 :
Job Source: DaMar StaffingElevance Health
Indianapolis
**Clinical Provider Auditor II** **Supports the Payment Integrity line of business** _Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations._ Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon
Job Source: Elevance HealthElevance Health
Southport, IN, United States
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
Job Source: Elevance HealthElevance Health
Beech Grove, IN, United States
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
Job Source: Elevance HealthPittsburgh Hires Veterans
Indianapolis, IN, United States
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 Plannin
Job Source: Pittsburgh Hires VeteransElevance Health
Indianapolis, IN, United States
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
Job Source: Elevance HealthIndianapolis, IN, United States
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
Email Alert for LTSS Provider Auditor jobs in Indianapolis, IN, United States
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