Coding Investigator Auditor - Work From Home

Health Care Service Corporation; Chicago (IL); Remote; USD 56,000 - 124,000; Full time

Job summary

Health Care Service Corporation is seeking an auditor for clinical, billing and coding claims to validate submissions and improve care affordability.

You will review services pre- and post-payment, research findings, and collaborate with medical directors, legal, pricing and database teams to resolve complex cases.

Qualifications

• Bachelor’s degree required; one year of business, law enforcement or regulatory experience may substitute for each year of college.
• Certified Coding Certification required or to be acquired 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 claims processing systems.
• Proficiency in Microsoft Word and Excel and health insurance databases.
• Strong verbal and written communication with physicians, members and providers; ability to document findings clearly.
• Excellent organizational and prioritization skills.

Responsibilities

• Audit clinical, billing, coding, and lowest cost setting reviews for services pre- and post-payment.
• Conduct research and prepare documentation of findings.
• Consult with special investigations and affordability of care as needed.
• Coordinate with medical director, special investigations, customer service, pass, network management, marketing, case management, medical review, legal, pricing and database teams.

Skills

Communication

Organizational skills

Time management

Microsoft Word & Excel

Education

Bachelor’s degree

Certified Coding Certification

AAPC Medical Coding Certification

Tools

Health insurance databases

Claims processing systems

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