Anthem Inc. Virginia Jobs

Job Information

Anthem, Inc. Clinical Provider Auditor II in Virginia Beach, Virginia


SHIFT: Day Job

SCHEDULE: Full-time

Clinical Provider Auditor II

Responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse.

Work from home

Primary duties may include, but are not limited to:

  • Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control.

  • Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to accurately document determinations and continue to next step in the claims lifecycle.

  • Researches new healthcare related questions as necessary to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in laws/regulations.

  • Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern.

  • Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation.

  • Assists with training of new associates.



  • AA/AS

  • Minimum of 4 years medical coding/auditing experience, including minimum of 1 year in fraud, waste abuse experience; or any combination of education and experience, which would provide an equivalent background.

  • Requires coding certification (CPC, CCS, CPMA).

  • Revenue Coding


  • Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology

  • Bachelors degree strongly preferred.

    We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

    REQNUMBER: PS56685