Coding Investigator Auditor
Health Care Service Corporation
Tulsa, Oklahoma
medical
management
health
health insurance
insurance
billing
cost
legislative policy
research
consulting
medical directors
directors
coordination
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September 29, 2022
Health Care Service Corporation
Tulsa, Oklahoma
FULL_TIME
Job Purpose:
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:
Registered Nurse (RN) with unrestricted license in state.
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:
CIC certification
3 years experience as Certified Facility Coder
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Requirements:
Expertise Nursing
Job Type Full-Time Regular
Location OK - Tulsa, TX - Richardson, IL - Chicago, NM - Albuquerque
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants.
If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1- to request reasonable accommodations.
Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "my account" and click on "View your job submissions".
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:
Registered Nurse (RN) with unrestricted license in state.
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:
CIC certification
3 years experience as Certified Facility Coder
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Requirements:
Expertise Nursing
Job Type Full-Time Regular
Location OK - Tulsa, TX - Richardson, IL - Chicago, NM - Albuquerque
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants.
If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1- to request reasonable accommodations.
Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "my account" and click on "View your job submissions".
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