At HCSC, employees are the cornerstone of the business and the foundation of its success. The company offers curated development plans that support growth and rewarding careers.
This role is responsible for auditing clinical, billing, and coding reviews for services before and after payment. The work includes using medical, contractual, legislative, policy, and other information to validate claims submitted and billed, conducting research, preparing documentation of findings, and consulting with special investigations and affordability of care teams as needed.
The position coordinates with multiple departments involved in each case, including medical directors, special investigations, customer service, PASS, network management, marketing, case management, medical review, legal, pricing, and database teams.
Bachelor’s degree, or equivalent business, law enforcement, or regulatory agency experience in place of college coursework.
Certified Coding Certification, or ability to obtain 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 standards such as URAC and NCQA, as well as health insurance legislation.
Understanding of claims processes and claims processing systems.
Proficiency with Microsoft Word, Excel, and health insurance databases.
Strong verbal and written communication skills with the ability to communicate with physicians, members, and providers and clearly explain findings.
Strong organizational and prioritization skills.
Preferred:
Current AAPC Medical Coding Certification.
Work from home.
Opportunity to join a purpose-driven health insurer focused on employee development.
Access to company benefits through the HCSC total rewards program.
Location
Chicago, Illinois, US
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$55,900 - $123,500
Remote work allowed
Yes
Posted
2 weeks ago