Coding Investigator Auditor - Oklahoma

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. The individual in this role will also conduct research, prepare documentation of findings, and consult with medical directors as needed. Additional duties include coordinating with all departments involved in each case such as special investigations, customer service, pass, network management, marketing, case management, medical review, legal, pricing, and database. Required 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 Qualifications and Additional Details Prefer individual to have an active Certified Professional Coder (CPC) certification, offered by the AAPC. 3 years clinical experience. Location: This position is available at our Tulsa, OK or Oklahoma City, OK offices. Schedule: This is a Flex (Hybrid) role: 3 days in office; 2 days remote. Monday - Friday position, standard business hours. Sponsorship: Sponsorship is not available. Benefits At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to support your life outside of work. Benefits include 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. Pay Transparency Statement The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. Base Pay Range $55,900.00 - $123,500.00 Exact compensation may vary based on skills, experience, and location. Equal Opportunity Employment We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are 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. #J-18808-Ljbffr HCSC