Remote Coding Auditor & Claims Investigator

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

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