Health Care Service Corporation
Coding Investigator Auditor
Health Care Service Corporation, California, Missouri, United States, 65018
Coding Investigator Auditor page is loaded## Coding Investigator Auditorlocations:
IL - Chicago:
IL - Jacksonville:
MT - Helena:
NM - Albuquerque:
IL - Quincytime type:
Full timeposted on:
Posted Todaytime left to apply:
End Date: November 10, 2025 (17 days left to apply)job requisition id:
R0046465At 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 performing 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 medical directors as needed. Coordination with all departments involved in each case required such as special investigations, customer service, pass, network management, marketing, case management, medical review, legal, pricing and database.### ## **Required Job Qualifications:*** ## Bachelor 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, 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:*** ## Registered Nurse (RN) with unrestricted license in state.* ## Certified Coder preferred* ## 3 plus years of claim adjudication/payment integrity* ## 3 years clinical experience## ## **This is a Telecommute (Remote) role:
Must reside within 250 miles of the office or anywhere within the posted state.**#LI-Remote#LI-DP1\*CA### ### **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 .The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.## 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.# # **Base Pay Range**$54,800.00 - $121,100.00Exact compensation may vary based on skills, experience, and location.For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities.Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren’t afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you’ll have to improve health care delivery in an open, collaborative environment. #J-18808-Ljbffr
IL - Chicago:
IL - Jacksonville:
MT - Helena:
NM - Albuquerque:
IL - Quincytime type:
Full timeposted on:
Posted Todaytime left to apply:
End Date: November 10, 2025 (17 days left to apply)job requisition id:
R0046465At 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 performing 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 medical directors as needed. Coordination with all departments involved in each case required such as special investigations, customer service, pass, network management, marketing, case management, medical review, legal, pricing and database.### ## **Required Job Qualifications:*** ## Bachelor 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, 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:*** ## Registered Nurse (RN) with unrestricted license in state.* ## Certified Coder preferred* ## 3 plus years of claim adjudication/payment integrity* ## 3 years clinical experience## ## **This is a Telecommute (Remote) role:
Must reside within 250 miles of the office or anywhere within the posted state.**#LI-Remote#LI-DP1\*CA### ### **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 .The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.## 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.# # **Base Pay Range**$54,800.00 - $121,100.00Exact compensation may vary based on skills, experience, and location.For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities.Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren’t afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you’ll have to improve health care delivery in an open, collaborative environment. #J-18808-Ljbffr