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Coding Investigator Auditor

Health Care Service Corporation
life insurance, parental leave, paid time off, paid holidays, tuition reimbursement, 401(k)
United States, Oklahoma, Tulsa
Jan 30, 2025

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 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) or Licensed Practical Nurse (LPN) with unrestricted license in state.
*3 years clinical experience

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

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 https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan.

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$54,800.00 - $121,100.00
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