Premera Blue Cross is dedicated to improving healthcare for its customers, and they are seeking a Payment Integrity Auditor I. In this role, you will conduct audits to ensure coding accuracy and compliance while collaborating with various internal teams.
Responsibilities
- 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
Skills
- Bachelor's Degree or equivalent combination of education and experience
- (1) year of related medical coding or auditing experience
- Certified Professional Coder Designation (CPC-A, CPC, CSS, CPMA) or equivalent
- Knowledge of health plan operations and claim adjudication processes
- Experience with facility, professional, and ancillary coding
- Familiarity with auditing software tools
Benefits
- 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.
- Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.
- Employee recognition program to celebrate anniversaries, team accomplishments, and more.
- 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.
Company Overview
- Premera is a leading health plan in the Pacific Northwest, providing comprehensive health benefits and tailored services. It was founded in 1945, and is headquartered in Mountlake Terrace, Washington, USA, with a workforce of 1001-5000 employees. Its website is https://www.premera.com.
Company H1B Sponsorship
- Premera Blue Cross has a track record of offering H1B sponsorships, with 3 in 2026, 20 in 2025, 29 in 2024, 13 in 2023, 25 in 2022, 15 in 2021, 5 in 2020. Please note that this does not guarantee sponsorship for this specific role.