Health Care Service Corporation
Health Care Service Corporation
Health Care Service Corporation (HCSC), Blue Cross Blue Shield Association की एक स्वतंत्र लाइसेंसधारी और अमेरिका की प्रमुख स्वास्थ्य बीमा एवं स्वास्थ्य सेवा संस्थाओं में से एक है। यह नियोक्ताओं, व्यक्तियों, परिवारों तथा Medicare और Medicaid के सदस्यों के लिए कवरेज और लाभ कार्यक्रमों के माध्यम से लगभग 2.3 करोड़ लोगों की सेवा करती है। स्वास्थ्य बीमा के अलावा, HCSC फार्मेसी सेवाएं, जीवन और दंत कवरेज तथा स्वास्थ्य डेटा प्रौद्योगिकी भी उपलब्ध कराती है। लगभग एक सदी के अनुभव के साथ, कंपनी बीमा, स्वास्थ्य सेवा और परामर्श के क्षेत्रों में काम करती है ताकि देखभाल तक पहुंच बढ़ाई जा सके, बेहतर स्वास्थ्य परिणामों का समर्थन किया जा सके और सदस्यों तथा समुदायों के लिए लागतों के प्रबंधन में सहायता मिल सके। इसके व्यापक संचालन से स्वास्थ्य लाभ, स्वास्थ्य सेवाओं, प्रौद्योगिकी, डेटा और संबंधित व्यावसायिक कार्यों में करियर के अवसर उपलब्ध होते हैं।

Coding Investigator Auditor (Remote, U.S.)

Health Care Service Corporation seeks a remote Coding Investigator Auditor to validate clinical, billing, and coding claims across eligible U.S. locations. The role audits payments, researches discrepancies, documents findings, and coordinates investigations.

विवरण

  • Review clinical, billing, coding, and lowest-cost-setting services before and after payment
  • Apply medical, contractual, legislative, policy, and related information to validate submitted and billed claims
  • Research relevant issues and records
  • Document audit findings clearly and accurately
  • Consult with special investigations and affordability-of-care teams when needed
  • Coordinate with the medical director, special investigations, customer service, PASS, network management, marketing, case management, medical review, legal, pricing, and database departments

आवश्यकताएँ

  • Bachelor’s degree required; one year of business, law enforcement, or regulatory agency experience may substitute for each year of college
  • Hold a certified coding credential or obtain one within 24 months of hire
  • Bring three years of experience with claims processing operations and reporting systems, including two years auditing or developing computer system reports
  • Understand accreditation standards such as URAC and NCQA, along with health insurance legislation
  • Understand claims processes and claims processing systems
  • Demonstrate PC proficiency with Microsoft Word, Excel, and health insurance databases
  • Communicate effectively in writing and verbally with physicians, members, and providers, and prepare and explain documented findings
  • Demonstrate strong organization and prioritization skills
  • Current AAPC Medical Coding Certification is preferred
  • Work remotely within the continental United States, excluding California, New York, Alaska, and Hawaii

लाभ

  • 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
  • Additional incentive programs
  • Professional development opportunities
  • Remote work arrangement

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