Remote Coding Investigator & Claims Auditor

Health Care Service Corp.; United States; Remote; USD 63,000 - 114,000; Full time

Job summary

Health Care Service Corporation (HCSC) is seeking a claims auditing professional to validate medical, billing and coding reviews for services before and after payment. You will research findings, document results and consult with medical directors and other stakeholders.

The role requires knowledge of URAC/NCQA standards, strong communication and organizational skills, and proficiency with Word/Excel. Remote work is possible for qualified candidates nationwide, with exclusions noted.

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.

Responsibilities

• Audit clinical, billing, coding and cost settings reviews for services pre- and post-payment.
• Conduct research and prepare documentation of findings.
• Coordinate with medical directors, special investigations, customer service, network management, pricing and other departments as needed.

Skills

Verbal & written communication

Organizational skills

PC proficiency (Word, Excel)

Knowledge of claims processing

Auditing/claims reporting experience

Education

Bachelor’s degree

Regulatory/agency experience substitute

Tools

Microsoft Word

Microsoft Excel

Job description

Health Care Service Corporation (HCSC) is seeking a claims auditing professional to validate medical, billing and coding reviews for services before and after payment. You will research findings, document results and consult with medical directors and other stakeholders.

The role requires knowledge of URAC/NCQA standards, strong communication and organizational skills, and proficiency with Word/Excel. Remote work is possible for qualified candidates nationwide, with exclusions noted.