Health Care Service Corporation
Health Care Service Corporation
Health Care Service Corporation (HCSC) ir Blue Cross Blue Shield Association neatkarīgs licences turētājs un nozīmīga ASV veselības apdrošināšanas un veselības aprūpes pakalpojumu organizācija. Tā apkalpo gandrīz 23 miljonus cilvēku, nodrošinot seguma un pabalstu programmas darba devējiem, privātpersonām, ģimenēm, kā arī Medicare un Medicaid dalībniekiem. Papildus veselības apdrošināšanai HCSC piedāvā aptieku pakalpojumus, dzīvības un zobārstniecības apdrošināšanu, kā arī veselības datu tehnoloģijas. Uzņēmumam ir gandrīz gadsimtu ilga pieredze darbā apdrošināšanas, veselības aprūpes un konsultāciju jomā, lai paplašinātu piekļuvi aprūpei, veicinātu labākus veselības rezultātus un palīdzētu dalībniekiem un kopienām pārvaldīt izmaksas. Tā plašā darbība rada karjeras iespējas veselības pabalstu, veselības aprūpes pakalpojumu, tehnoloģiju, datu un saistīto uzņēmējdarbības funkciju jomās.

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.

Apraksts

  • 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

Prasības

  • 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

Priekšrocības

  • 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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