Coding Investigator Auditor

🔥 0 minutes ago

🌽 Illinois, Montana, +3 more states – Remote

🌽 Illinois – Remote 🦬 Montana – Remote 🌶️ New Mexico – Remote 🌪️ Oklahoma – Remote 🤠 Texas – Remote

💵 $63.3k - $114.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 medical director, special investigations, customer service, PASS, network management, marketing, case management, medical review, legal, pricing, and database departments

🎯 Requirements

• 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 including Microsoft Word, Excel, and health insurance databases • Verbal and written communication skills to communicate with physicians, members, and providers and compose and explain documented findings • Organizational and prioritization skills • Current AAPC Medical Coding Certification preferred • Must be able to work remotely within the continental United States, excluding California, New York, Alaska, and Hawaii

🏖️ Benefits

• Annual incentive bonus plan • 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 • Other incentives • Professional development opportunities • Remote work arrangement