Remote Coding & Billing Claims Auditor

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

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