Coding Investigator Auditor

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $55.9k - $123.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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Health Care Service Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Health Care Service Corporation is an independent licensee of the Blue Cross Blue Shield Association, serving nearly 23 million people across the United States with a wide range of health benefit solutions. The company provides health coverage options for various groups, including employers, individuals, families, as well as Medicare and Medicaid plans. In addition to health insurance, HCSC offers services such as pharmacy solutions, life and dental insurance, and health data technology. With nearly a century of experience, HCSC is dedicated to improving access to quality care, enhancing health outcomes, and reducing costs while maintaining a deep commitment to its members and local communities.

📋 Description

• Audit clinical, billing, coding, and lowest-cost-setting reviews for services before and after payment • Utilize medical, contractual, legislative, policy, and other information to validate submitted and billed claims • Conduct research • Prepare documentation of findings • Consult with Special Investigation and Affordability of Care areas as needed • Coordinate with departments involved in each case, including medical director, special investigations, customer service, PASS, network management, marketing, case management, medical review, legal, pricing, and database teams

🎯 Requirements

• Bachelor’s degree; one year of business, law enforcement, or regulatory agency experience may substitute for each year of college • Certified Coding Certification, or ability to acquire it within 24 months of hire • 3 years of experience in claims processing operations and reporting systems • 2 years of experience auditing or developing computer system reports • Knowledge of accreditation standards, including URAC and NCQA • Knowledge of 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 to communicate with physicians, members, and providers and explain documented findings • Organizational and prioritization skills • Current AAPC Medical Coding Certification preferred

🏖️ Benefits

• Curated development plans and professional development investment • 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 • Incentives • Annual incentive bonus plan