Payment Integrity Auditor I

Payment Integrity Auditor I

Join Our Team : Do Meaningful Work and Improve People's Lives

Our purpose, to improve customers' lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we are fostering a culture that emphasizes employee growth, collaborative innovation, and inspired leadership. We are dedicated to creating an environment where employees can excel and where top talent is attracted, retained, and thrives. As a testament to these efforts, Premera has been recognized on the 2025 America's Dream Employers list. Newsweek honored Premera as one of America's Greatest Workplaces, America's Greatest Workplaces for Inclusion, and America's Greatest Workplaces For Mental Well-Being, Forbes ranked Premera among America's Best Midsize Employers for the fourth time.

Learn how Premera supports our members, customers and the communities that we serve through our 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 is responsible for conducting 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 be able to clearly document and communicate audit results and will collaborate with internal teams including the Special Investigation Unit and Payment Integrity Specialists. This role requires medical coding experience and solid written and oral communication.

This is a hybrid role located on our campus in Mountlake Terrace, Washington.

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

Preferred Qualifications

Knowledge, Skills, and Abilities

Physical Requirements

Premera Total Rewards

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including :

For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.

Equal Employment Opportunity / Affirmative Action

Premera is an equal opportunity / affirmative action employer. Premera seeks to attract and retain the most qualified individuals 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 for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.

The pay for this role will vary based on a range of factors including, but not limited to, a candidate's geographic location, market conditions, and specific skills and experience.

The salary range for this role is posted below; we generally target up to and around the midpoint of the range.

National Plus Salary Range : $58,100.00 - $87,200.00

We're happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We're committed to creating an environment where all employees are celebrated for their unique skills and contributions.