Premera Blue Cross
Payment Integrity Auditor I
Premera Blue Cross, Mountlake Terrace, Washington, United States, 98043
Overview
Join to apply for the
Payment Integrity Auditor I
role at
Premera Blue Cross . Workforce Classification: Hybrid. This is a hybrid role located on our campus in Mountlake Terrace, Washington. Our purpose is to improve customers’ lives by making healthcare work better. Premera is committed to employee growth, collaborative innovation, and inspired leadership. We have been recognized on the 2025 America’s Dream Employers list and by Newsweek, Forbes, and other organizations for workplace excellence. Learn more about how we support our members and communities at Healthsource blog: https://healthsource.premera.com/. As a
Payment Integrity Auditor I , you will support the overall objectives of the Payment Integrity office. This role conducts pre-payment and post-payment claim audits to identify improper payments due to billing errors, coding discrepancies, and policy non-compliance. Audits include reviewing medical records, applying clinical and coding knowledge, analyzing provider billing patterns, and evaluating related claim history to ensure accurate payment integrity. You must document and communicate audit results clearly and collaborate with internal teams including the Special Investigation Unit and Payment Integrity Specialists. A medical coding background and strong written and verbal communication skills are required. What you’ll do
Conduct entry-level audits of professional and facility claims to ensure coding accuracy and compliance with contractual, coding, payment policy, and regulatory standards. Review itemized bills, medical records, and other claim documentation to verify coding accuracy and appropriateness of charges. Validate coding accuracy for CPT, HCPCS, ICD-10-CM, and DRG. Identify and report coding discrepancies or errors and recommend adjustments where appropriate. Identify opportunities for fraud, waste, and abuse prevention and control. Maintain accurate and detailed records of audit findings and outcomes for reporting purposes. Collaborate with internal teams (e.g., claims processing, provider relations, special investigations unit). Utilize auditing software and systems to document, track, and analyze claims data. Stay updated on coding guidelines, payer policies, and industry standards, including CMS regulations. Participate in ongoing training and development to enhance coding and auditing skills. Support Payment Integrity team initiatives by contributing to process improvement efforts and team goals. What you’ll bring
Required Qualifications
Bachelor's Degree or equivalent combination of education and experience. One year of related medical coding or auditing experience. Certified Professional Coder Designation (CPC-A, CPC, CSS, CPMA) or equivalent. Preferred Qualifications
Knowledge of health plan operations and claim adjudication processes. Experience with facility, professional, and ancillary coding. Familiarity with auditing software tools. Knowledge, Skills, And Abilities
Basic understanding of CPT, HCPCS, ICD-10-CM, and DRG coding. Strong attention to detail and analytical thinking. Effective written and verbal communication skills. Physical Requirements
The following have been identified as essential physical requirements of this job and must be performed with or without accommodation: This is primarily a sedentary role with 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 move objects, including the human body. Ability to use a keyboard and to communicate clearly in person and over the telephone. Total Rewards
Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Rewards include physical, financial, emotional, and community benefits, including: Medical, vision, and dental coverage with low employee premiums. Voluntary benefit offerings, including pet insurance. Life and disability insurance. Retirement programs, including a 401(k) employer match and a pension plan vested after 3 years of service. Wellness incentives and mental well-being resources for you and your dependents. Generous paid time off. Tuition assistance for undergraduate and graduate degrees. Employee recognition program. For hybrid employees, on-campus resources, networking opportunities, and team engagement are available. On-campus perks include commuter benefits, free on-site parking, onsite cafes, wellness events, and a fitness and well-being center. Equal employment opportunity
Premera is an equal opportunity/affirmative action employer. We welcome applicants 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, contact Premera Human Resources at careers@premera.com or 425-918-4785. The pay for this role varies based on location, market conditions, and skills and experience. The salary range for this role is posted below. National Plus Salary Range: $58,100.00 - $87,200.00. National Plus range is used in higher cost of labor markets including Western Washington and Alaska. We’re happy to discuss compensation during the interview. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions.
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Join to apply for the
Payment Integrity Auditor I
role at
Premera Blue Cross . Workforce Classification: Hybrid. This is a hybrid role located on our campus in Mountlake Terrace, Washington. Our purpose is to improve customers’ lives by making healthcare work better. Premera is committed to employee growth, collaborative innovation, and inspired leadership. We have been recognized on the 2025 America’s Dream Employers list and by Newsweek, Forbes, and other organizations for workplace excellence. Learn more about how we support our members and communities at Healthsource blog: https://healthsource.premera.com/. As a
Payment Integrity Auditor I , you will support the overall objectives of the Payment Integrity office. This role conducts pre-payment and post-payment claim audits to identify improper payments due to billing errors, coding discrepancies, and policy non-compliance. Audits include reviewing medical records, applying clinical and coding knowledge, analyzing provider billing patterns, and evaluating related claim history to ensure accurate payment integrity. You must document and communicate audit results clearly and collaborate with internal teams including the Special Investigation Unit and Payment Integrity Specialists. A medical coding background and strong written and verbal communication skills are required. What you’ll do
Conduct entry-level audits of professional and facility claims to ensure coding accuracy and compliance with contractual, coding, payment policy, and regulatory standards. Review itemized bills, medical records, and other claim documentation to verify coding accuracy and appropriateness of charges. Validate coding accuracy for CPT, HCPCS, ICD-10-CM, and DRG. Identify and report coding discrepancies or errors and recommend adjustments where appropriate. Identify opportunities for fraud, waste, and abuse prevention and control. Maintain accurate and detailed records of audit findings and outcomes for reporting purposes. Collaborate with internal teams (e.g., claims processing, provider relations, special investigations unit). Utilize auditing software and systems to document, track, and analyze claims data. Stay updated on coding guidelines, payer policies, and industry standards, including CMS regulations. Participate in ongoing training and development to enhance coding and auditing skills. Support Payment Integrity team initiatives by contributing to process improvement efforts and team goals. What you’ll bring
Required Qualifications
Bachelor's Degree or equivalent combination of education and experience. One year of related medical coding or auditing experience. Certified Professional Coder Designation (CPC-A, CPC, CSS, CPMA) or equivalent. Preferred Qualifications
Knowledge of health plan operations and claim adjudication processes. Experience with facility, professional, and ancillary coding. Familiarity with auditing software tools. Knowledge, Skills, And Abilities
Basic understanding of CPT, HCPCS, ICD-10-CM, and DRG coding. Strong attention to detail and analytical thinking. Effective written and verbal communication skills. Physical Requirements
The following have been identified as essential physical requirements of this job and must be performed with or without accommodation: This is primarily a sedentary role with 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 move objects, including the human body. Ability to use a keyboard and to communicate clearly in person and over the telephone. Total Rewards
Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Rewards include physical, financial, emotional, and community benefits, including: Medical, vision, and dental coverage with low employee premiums. Voluntary benefit offerings, including pet insurance. Life and disability insurance. Retirement programs, including a 401(k) employer match and a pension plan vested after 3 years of service. Wellness incentives and mental well-being resources for you and your dependents. Generous paid time off. Tuition assistance for undergraduate and graduate degrees. Employee recognition program. For hybrid employees, on-campus resources, networking opportunities, and team engagement are available. On-campus perks include commuter benefits, free on-site parking, onsite cafes, wellness events, and a fitness and well-being center. Equal employment opportunity
Premera is an equal opportunity/affirmative action employer. We welcome applicants 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, contact Premera Human Resources at careers@premera.com or 425-918-4785. The pay for this role varies based on location, market conditions, and skills and experience. The salary range for this role is posted below. National Plus Salary Range: $58,100.00 - $87,200.00. National Plus range is used in higher cost of labor markets including Western Washington and Alaska. We’re happy to discuss compensation during the interview. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions.
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