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Responsibilities:
- Lead end-to-end audits of provider charge masters, billing practices, and associated claims.
- Design and enhance audit frameworks, models, dashboards, and templates.
- Evaluate audit findings and exercise professional judgement to determine materiality.
Skills:
- Expertise in CPT/HCPCS coding, CMS billing guidelines, and provider reimbursement methodologies.
- Advanced experience with Microsoft Office Suite products.
- Experience translating audit results into actionable recommendations for senior leadership.
Experience:
- Minimum of five (5) years of progressive experience conducting provider billing, reimbursement, or payment integrity audits.
- Experience with Commercial and Medicare Advantage plans.
- Demonstrated experience independently leading complex, high‑impact audits.
Capital Blue Cross
Capital Blue Cross is committed to going the extra mile for their team and community. Employees have consistently voted it one of the "Best Places to Work in PA", reflecting a culture that values its employees.