Role Description Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together, we will achieve our mission to enhance the health and well-being of the people and communities we serve. The Auditor, Payment Integrity role conducts pharmacy claim audits for Independence Blue Cross to ensure accurate provider payments, detect fraud, waste, or abuse, and improve audit processes. - Conduct audits of claims submitted to Independence Blue Cross (IBX) to ensure accuracy of provider payments and charges. - Analyze provider billing patterns to detect potential fraud, waste, or abuse. - Perform audits through daily reviews, live audits, and desk audits to identify inappropriate billing practices. - Review and verify provider billing records, collaborating with CFID audit analysts, auditors, investigators, internal, and external sectors. - Execute standard provider audit assignments using sound audit methodologies to uncover patterns of abuse or fraud. - Screen and audit claim samples—both summary and detailed—to select cases for further review. - Initiate and validate claim adjustments, maintain comprehensive audit documentation, and prepare statistical reports. - Identify and escalate potential provider fraud or abuse to management. - Contribute to the development and implementation of new audit processes and functions. Qualifications - Certified Pharmacy Technician (CPhT) required. - Minimum of four (4) years of relevant experience, including: - At least two (2) years in retail or hospital pharmacy. - At least two (2) years in pharmacy audit. - Extensive understanding of healthcare provider audit practices and medical terminology. - Familiarity with fraud, waste, and abuse detection methodologies. - Strong written and verbal communication skills for reporting and presenting audit findings. - Proficiency in Microsoft Office applications, including Excel, Word, Outlook, SharePoint, and Access. - Advanced Excel skills (pivot tables, VLOOKUP, data analysis). - Experience with pharmacy claims systems such as RxTrack and RxClaim is preferred but not required. Requirements - Fully Remote: This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence’s physical office locations to perform the work. - Must have an Android or iOS device that is compatible with the free Microsoft Authenticator app. Benefits - IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

• Lead the audit and final review of job files to ensure accuracy, completeness, and full compliance with carrier and TPA standards. • Oversee WIP job file management, audit readiness, and file lifecycle performance. • Identify discrepancies, mitigate risk, and ensure proper documentation standards are met. • Serve as a subject matter expert on file quality, compliance, and best practices. • Collaborate with estimators, project managers, and leadership to improve file quality and workflow efficiency. • Drive continuous improvement in QA processes, turnaround times, and audit success rates. • Support escalations and complex file reviews.

Role Description As a Coding Auditor, you will be a central figure ensuring accurate and timely reimbursement by proactively resolving medical coding claim defects before billing. You will play a vital role in optimizing our revenue cycle and maintaining financial integrity. - Meticulously research and review coding-related claim denials. - Provide expert guidance on corrections to prevent future issues and recover lost revenue. - Proactively address pre-billing resolution of coding defects, safeguarding against reimbursement impacts. - Combine a robust understanding of medical coding and reimbursement methodologies. - Demonstrate exceptional analytical skills and meticulous attention to detail. - Exhibit a proactive problem-solving approach, driven by a commitment to maximizing financial accuracy and efficiency. As a remote employee, we will provide you with the equipment needed to work from home, including a laptop, docking station, dual monitors, and accessories. Qualifications - High school diploma or equivalent. - Minimum of one (1) year of coding experience or two (2) years experience in any capacity in a health care environment or medical office setting. - Requires one of the following coding certifications from either the American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA): - Certified Professional Coder (CPC) - Certified Coding Associate (CCA) - Certified Coding Specialist (CCS) - Certified Coding Specialist-Physician (CCS-P) - Registered Health Information Technician (RHIT) - Registered Health Information Administrator (RHIA) - Working knowledge of human anatomy and physiology, disease processes, and demonstrated knowledge of medical terminology. - Requires critical thinking and analytical skills, decisive judgment, and the ability to work with minimal supervision. - Applicants must be able to work under pressure to meet imposed deadlines and take appropriate actions. Requirements - Associate degree in related field (preferred). - Healthcare revenue cycle experience preferred.

• Conduct on-site and remote audits across supplier facilities, warehouses, and retail environments • Assess compliance against client standards, regulatory requirements, and industry best practice • Identify risks, non-conformances, and opportunities for improvement • Produce clear, accurate, and timely audit reports • Engage professionally with suppliers and stakeholders, providing insight and challenge where appropriate