Premera
**Workforce Classification:**Hybrid**Join Our Team: Do Meaningful Work and Improve People’s Lives**Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.To better serve our customers, we are fostering a culture that emphasizes employee growth, collaborative innovation, and inspired leadership. We are dedicated to creating an environment where employees can excel and where top talent is attracted, retained, and thrives. As a testament to these efforts, Premera has been recognized on the
list. Newsweek honored Premera as one of , , and , Forbes ranked Premera among
for the fourth time.Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog:
.As a **Payment Integrity Auditor II**, you will support the overall objectives of the Payment Integrity office. This role will support the execution of Premera’s corporate wide claim payment accuracy strategy through conducting claim audits, identifying trends in coding errors, and informing coding education material for internal and external audiences. The Auditor II plays a critical role in identifying audit opportunities, complex analysis, and provider billing investigation. This role requires a deep understanding of medical claims adjudication, coding compliance, and regulatory guidelines. You will be responsible for conducting complex audits involving high-dollar claims, specialty provider billing, contractual compliance, as well as mentoring junior auditors, and will collaborate across internal teams including the Special Investigation Unit and Payment Integrity Specialists. This role requires medical coding experience, analytical skills, solid written and oral communication, and organizational adeptness.**This is a hybrid role located on our campus in Mountlake Terrace, Washington.****What you’ll do:*** Perform intermediate-level audits of professional and facility claims including more complex coding and billing scenarios to ensure accuracy of billing and compliance with contractual, coding, payment policy, and regulatory standards.* Conduct detailed reviews of itemized bills, medical records, and other claims data to validate coding accuracy and appropriateness of charges.* Identify trends or patterns in provider coding errors and assist in developing provider education.* Evaluate and quantify claim payment impacts associated with audit findings.* Collaborate with cross-functional teams to address and resolve complex audit findings and discrepancies.* Prepare detailed audit reports and summaries for leadership and other internal stakeholders.* Assist in developing and refining audit workflows and procedures to improve accuracy and efficiency.* Mentor and provide guidance to lower-level auditors to support professional development.* Participate in the development and delivery of training sessions on coding updates and auditing best practices.* Stay informed about changes in coding standards, payer policies, and healthcare regulations, applying them to audit activities.* Contribute to special projects and initiatives within the Payment Integrity office, including process improvement efforts.**What you’ll bring:****Required Qualifications*** Bachelor's Degree or equivalent combination of education and experience.* (3) years of related medical coding/auditing experience.* Certified Professional Coder Designation (CPC, CSS, CPMA) or equivalent.**Preferred Qualifications*** Experience auditing multiple claim types, including DRG, itemized bill review, and level of care reviews.* Intermediate familiarity with federal and state regulatory requirements related to claims processing.* Proficiency with auditing software and/or processes with strong technical aptitude.* Familiarity with industry standard payment policies.**Knowledge, Skills, and Abilities*** Strong analytical and problem-solving skills.* Ability to train and mentor less experienced auditors.**Physical Requirements**The following have been identified as essential physical requirements of this job and must be performed with or without an accommodation:* This is primarily a sedentary role which requires the ability to exert up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body.* This role requires the ability to use a keyboard and to communicate clearly and understandably in person and over the telephone.**Premera total rewards**Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:* Medical, vision, and dental coverage with low employee premiums.* Voluntary benefit offerings, including pet insurance for paw parents.* Life and disability insurance.* Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.* Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.* Generous paid time off to reenergize.* Employee recognition program to celebrate anniversaries, team accomplishments, and more.For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.* Commuter perks make your trip to work less impactful on the environment and your wallet.* Free convenient on-site parking.* Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.* Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.* Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.**Equal employment opportunity/affirmative action:**Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.The salary range for this role is posted below; we generally target up to and around the midpoint of the range.**National Plus Salary Range:**$60,300.00 - $96,500.00*\*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska**.*We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions.At Premera, we make healthcare work better. By focusing on improving our customers’ experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives.
As the leading health plan in the Pacific Northwest, #J-18808-Ljbffr
list. Newsweek honored Premera as one of , , and , Forbes ranked Premera among
for the fourth time.Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog:
.As a **Payment Integrity Auditor II**, you will support the overall objectives of the Payment Integrity office. This role will support the execution of Premera’s corporate wide claim payment accuracy strategy through conducting claim audits, identifying trends in coding errors, and informing coding education material for internal and external audiences. The Auditor II plays a critical role in identifying audit opportunities, complex analysis, and provider billing investigation. This role requires a deep understanding of medical claims adjudication, coding compliance, and regulatory guidelines. You will be responsible for conducting complex audits involving high-dollar claims, specialty provider billing, contractual compliance, as well as mentoring junior auditors, and will collaborate across internal teams including the Special Investigation Unit and Payment Integrity Specialists. This role requires medical coding experience, analytical skills, solid written and oral communication, and organizational adeptness.**This is a hybrid role located on our campus in Mountlake Terrace, Washington.****What you’ll do:*** Perform intermediate-level audits of professional and facility claims including more complex coding and billing scenarios to ensure accuracy of billing and compliance with contractual, coding, payment policy, and regulatory standards.* Conduct detailed reviews of itemized bills, medical records, and other claims data to validate coding accuracy and appropriateness of charges.* Identify trends or patterns in provider coding errors and assist in developing provider education.* Evaluate and quantify claim payment impacts associated with audit findings.* Collaborate with cross-functional teams to address and resolve complex audit findings and discrepancies.* Prepare detailed audit reports and summaries for leadership and other internal stakeholders.* Assist in developing and refining audit workflows and procedures to improve accuracy and efficiency.* Mentor and provide guidance to lower-level auditors to support professional development.* Participate in the development and delivery of training sessions on coding updates and auditing best practices.* Stay informed about changes in coding standards, payer policies, and healthcare regulations, applying them to audit activities.* Contribute to special projects and initiatives within the Payment Integrity office, including process improvement efforts.**What you’ll bring:****Required Qualifications*** Bachelor's Degree or equivalent combination of education and experience.* (3) years of related medical coding/auditing experience.* Certified Professional Coder Designation (CPC, CSS, CPMA) or equivalent.**Preferred Qualifications*** Experience auditing multiple claim types, including DRG, itemized bill review, and level of care reviews.* Intermediate familiarity with federal and state regulatory requirements related to claims processing.* Proficiency with auditing software and/or processes with strong technical aptitude.* Familiarity with industry standard payment policies.**Knowledge, Skills, and Abilities*** Strong analytical and problem-solving skills.* Ability to train and mentor less experienced auditors.**Physical Requirements**The following have been identified as essential physical requirements of this job and must be performed with or without an accommodation:* This is primarily a sedentary role which requires the ability to exert up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body.* This role requires the ability to use a keyboard and to communicate clearly and understandably in person and over the telephone.**Premera total rewards**Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:* Medical, vision, and dental coverage with low employee premiums.* Voluntary benefit offerings, including pet insurance for paw parents.* Life and disability insurance.* Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.* Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.* Generous paid time off to reenergize.* Employee recognition program to celebrate anniversaries, team accomplishments, and more.For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.* Commuter perks make your trip to work less impactful on the environment and your wallet.* Free convenient on-site parking.* Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.* Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.* Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.**Equal employment opportunity/affirmative action:**Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.The salary range for this role is posted below; we generally target up to and around the midpoint of the range.**National Plus Salary Range:**$60,300.00 - $96,500.00*\*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska**.*We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions.At Premera, we make healthcare work better. By focusing on improving our customers’ experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives.
As the leading health plan in the Pacific Northwest, #J-18808-Ljbffr