Experience Details: Strong familiarity with ICD-9/10, DRG, CPT/HCPCS coding, or experience with and knowledge of multiple provider reimbursement and pricing methodologies (DRG, SPC, OFS, POC, Global Pricing, Per Diem etc.), or demonstrated proficient working knowledge of at least three of the following: medical terminology, claim audit procedures, provider contracts, claims processing procedures and guidelines, provider authorizations, provider billing, medical coding, concurrent review. This is a senior-level technical position in the post-payment provider audit function intended to analyze assigned provider claims for risk of over and under payments to perform onsite and desk reviews in support of the business unit's objective to ensure all incorrectly billed and paid claims are adjusted accordingly to help control medical cost spend.