Senior Provider Audit Specialist

This senior-level technical role focuses on analyzing post-payment provider claims to identify risks of over and under payments, ensuring billing and coding accuracy through clinical and financial reviews. The position involves conducting onsite and desk audits, validating medical records, and coordinating with provider executives to resolve claim discrepancies and control medical cost spend. The role requires a clinical certification to independently assess claims from clinical, coding, and billing perspectives while ensuring compliance with contracts and industry standards.