Coding Investigator Auditor

Health Care Service Corporation
United States, Illinois, Chicago
300 East Randolph Street (Show on map)
Oct 30, 2024
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. 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's Degree; in lieu of degree one year of claims or coding experience, may substitute for each year of college. Certified Coding Certification (CPC, COC, CCS, CCS-P, RHIT, RHIA) 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. Adhere to time management, production and quality standards as set by the department. Professional communication skills, oral and written. Prioritize multiple assignments and multiple spreadsheets, documents, and reports. Industry knowledge of Medicare regulations and payment policies, including OPPS Proficient in computer applications such as Microsoft Excel, Teams, PowerPoint, Word, and Outlook Preferred Job Qualifications: 2+ years of claims processing or claim knowledge, coding experience, including ICD-10-CM, CPT, professional Evaluation and Management, and modifiers. Professional licensures including: LPC, LCSW, RN, PT, DC This role has the ability to be 100% remote to the right candidate, NO VISA sponsorship is available for this role. Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! HCSC Employment Statement: We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, 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$53,500.00 - $118,100.00