Health Care Service Corporation
Health Care Service Corporation
Health Care Service Corporation (HCSC) — Blue Cross Blue Shield Association’ning mustaqil litsenziya egasi va AQShdagi yirik tibbiy sug‘urta hamda sog‘liqni saqlash xizmatlari tashkilotlaridan biridir. Kompaniya ish beruvchilar, jismoniy shaxslar, oilalar, shuningdek Medicare va Medicaid a’zolari uchun sug‘urta qamrovi va imtiyozlar dasturlari orqali qariyb 23 million kishiga xizmat ko‘rsatadi. HCSC tibbiy sug‘urtadan tashqari, dorixona xizmatlari, hayot va stomatologik sug‘urta hamda sog‘liq ma’lumotlari texnologiyalarini taqdim etadi. Qariyb bir asrlik tajribaga ega kompaniya sug‘urta, sog‘liqni saqlash va konsalting sohalarida faoliyat yuritib, tibbiy yordamdan foydalanish imkoniyatlarini kengaytirish, salomatlik natijalarini yaxshilash va a’zolar hamda jamoalar uchun xarajatlarni boshqarishga yordam beradi. Uning keng ko‘lamli faoliyati sog‘liq imtiyozlari, tibbiy xizmatlar, texnologiya, ma’lumotlar va turdosh biznes yo‘nalishlarida karyera imkoniyatlarini yaratadi.

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.

Tavsif

  • 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

Talablar

  • 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

Imtiyozlar

  • 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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