Health Care Service Corporation
Coding Investigator Auditor
Health Care Service Corporation, Chicago, Illinois, United States, 60290
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.
Responsibilities This position is responsible for performing clinical, billing, coding and lowest cost setting reviews for services pre and post payment using medical, contractual, legislative, policy, and other information to validate claims submitted and billed. Conduct research, prepare documentation of findings, and consult with medical directors as needed. Coordinate with all departments involved in each case, such as 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 experience in claims processing operations and reporting systems, including 2 years experience in auditing or developing computer system reports. Knowledge of accreditation, such as URAC and NCQA standards and health insurance legislation. Awareness of claims processes and claims processing systems. PC proficiency including 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 and prioritization skills.
Preferred Job Qualifications Registered Nurse (RN) with unrestricted license in state. Certified Coder preferred. 3 plus years of claim adjudication/payment integrity. 3 years clinical experience.
Telecommute (Remote) Role Must reside within 250 miles of the office or anywhere within the posted state. Location: CA.
Compensation: $54,800.00 - $121,100.00. 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.
To learn more about available benefits, please visit https://careers.hcsc.com/totalrewards.
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Join HCSC and be part of a purpose-driven company that will invest in your professional development.
Responsibilities This position is responsible for performing clinical, billing, coding and lowest cost setting reviews for services pre and post payment using medical, contractual, legislative, policy, and other information to validate claims submitted and billed. Conduct research, prepare documentation of findings, and consult with medical directors as needed. Coordinate with all departments involved in each case, such as 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 experience in claims processing operations and reporting systems, including 2 years experience in auditing or developing computer system reports. Knowledge of accreditation, such as URAC and NCQA standards and health insurance legislation. Awareness of claims processes and claims processing systems. PC proficiency including 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 and prioritization skills.
Preferred Job Qualifications Registered Nurse (RN) with unrestricted license in state. Certified Coder preferred. 3 plus years of claim adjudication/payment integrity. 3 years clinical experience.
Telecommute (Remote) Role Must reside within 250 miles of the office or anywhere within the posted state. Location: CA.
Compensation: $54,800.00 - $121,100.00. 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.
To learn more about available benefits, please visit https://careers.hcsc.com/totalrewards.
#J-18808-Ljbffr