Coding Investigator Auditor - Work From Home

HCSC Group; United States; Remote; USD 63,000 - 114,000; Full time

Job summary

HCSC is seeking a Claims Audit Specialist to review clinical, billing, coding and cost-setting reviews for services before and after payment. You will research, document findings, and consult with specialists across departments.

The role requires a Bachelor’s degree, coding certification or progress toward it, and strong communication skills. The position supports a remote work arrangement within the continental United States (excluding CA, NY, AK, HI) and involves collaboration with medical

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.
• 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

Responsibilities

• Audit clinical, billing, coding, and lowest-cost setting reviews for services pre and post payment.
• Research and prepare documentation of findings and consult with special investigations and affordability of care as needed.
• Coordinate with medical director special investigations, customer service, pass, network management, pricing and database.
• Communicate findings to physicians, members and providers and explain document findings.
• Collaborate with multiple departments to ensure efficient resolution of cases.

Skills

Auditing

Verbal communication

Written communication

Regulatory knowledge

Organizational skills

Prioritization

MS Word

Excel

Health insurance databases

Education

Bachelor’s degree

Tools

MS 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.

Job Summary

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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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan.

This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.

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.

Base Pay Range

$63,300.00 - $114,300.00

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