Coding Investigator Auditor - Work From Home

HCSC Group; Northern (KY); Hybrid; USD 63,000 - 114,000; Full time

Job summary

HCSC is seeking an experienced health care claims auditor to review clinical, billing, and coding for pre- and post-payment validations. You will research findings, document results, and consult with the affordability of care team as needed.

You will coordinate with medical directors, customer service, network management, pricing and data teams to ensure accurate, compliant claim processing across departments.

Qualifications

• Bachelor's degree required; experience substituting for college is allowed.
• Certified Coding Certification or obtain within 24 months of hire.
• 3 years of claims processing operations and reporting systems experience.
• 2 years of auditing or developing computer system reports experience.
• Knowledge of URAC/NCQA standards and health insurance legislation.

Responsibilities

• Audit clinical, billing, coding and lowest cost setting reviews for services pre and post payment.
• Research and document findings; consult with special investigations and affordability of care teams as needed.
• Coordinate with medical director special investigations, customer service, pricing and data teams.
• Collaborate with pricing, network management, marketing, case management, legal and other departments on cases.

Education

Bachelor's degree

Certified Coding Certification

Tools

Microsoft Word

Excel

Health insurance databases

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

Compensation: $63,300.00 - $114,300.00

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. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.