Coding Investigator Auditor - Work From Home

Human Resources; Chicago (IL); Remote; USD 56,000 - 124,000; Full time

Benefits offered by this job

Remote work

Job summary

HCSC is seeking a claims auditing professional to review clinical, billing, coding, and cost-setting reviews pre- and post-payment. You will research findings, document them thoroughly, and consult with special investigations and affordability teams as needed.

The role requires in-depth knowledge of claims processes, URAC/NCQA standards, and strong communication with physicians and providers. A Bachelor's degree and coding certification (or plan to obtain) are required, with remote-friendly

Qualifications

• Bachelor's degree required; one year of business, law enforcement, or regulatory experience may substitute for each year of college.
• Certified Coding Certification or must acquire within 24 months of hire.
• 3 years of claims processing operations and reporting systems experience, including 2 years auditing or developing computer system reports.
• Knowledge of URAC/NCQA standards and health insurance legislation.
• Awareness of claims processes and systems.
• Proficiency in MS Word/Excel and health insurance databases.
• Strong verbal and written communication with physicians, members, and providers.
• Excellent organizational and prioritization skills.

Responsibilities

• Audit clinical, billing, coding and lowest cost setting reviews for services pre and post payment, using medical, contractual and policy information.
• Conduct research and prepare documentation of findings; consult with special investigations and affordability of care as needed.
• Coordinate with multiple departments including medical director investigations, customer service, pricing and legal to resolve cases.

Skills

Auditing

Verbal communication

Written communication

Regulatory knowledge

Education

Bachelor's degree

Tools

Microsoft Word

Microsoft Excel

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

This position is responsible for auditing clinical, billing, coding and lowest cost setting reviews for services pre and post payment utilizing medical, contractual, legislative, policy, and other information to validate claims submitted and billed. Conducting research. Preparing documentation of findings and consulting with special investigation and the affordability of care area as needed. Coordinating with all departments involved in each case required such as medical director special investigations, customer service, pass, network management, marketing, case management, medical review, legal, pricing and database.

Required Job Qualifications:

• Bachelor's degree; one year of business experience, law enforcement experience, or regulatory agency experience may substitute for each year of college.
• Certified Coding Certification, or acquire within 24 months of hire
• 3 years of experience in claims processing operations and reporting systems, including 2 years of experience in auditing or developing computer system reports.
• Knowledge of accreditation, i.e. URAC, NCQA standards and health insurance legislation.
• Awareness of claims processes and claims processing systems.
• PC proficiency to include Microsoft Word and Excel and health insurance databases.
• Verbal and written communication skills with ability to communicate to physicians, members and providers and compose and explain document findings.
• Organizational skills and prioritization skills

Preferred Job Qualifications:

• Current AAPC Medical Coding Certification

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Compensation: $55,900.00 - $123,500.00

Exact compensation may vary based on skills, experience, and location

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

To learn more about available benefits, please click https://careers.hcsc.com/totalrewards