Coding Investigator Auditor

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Perform audits on clinical, billing, coding, and cost-efficient service reviews prior to and following payment.

• Leverage medical, contractual, legislative, policy, and other relevant information to verify submitted and billed claims.

• Engage in research activities.

• Compile documentation of findings.

• Collaborate with the Special Investigation and Affordability of Care teams as necessary.

• Coordinate with various departments involved in each case, including the medical director, special investigations, customer service, PASS, network management, marketing, case management, medical review, legal, pricing, and database teams.

⛳️ Requirements

• A Bachelor’s degree; one year of experience in business, law enforcement, or a regulatory agency can substitute for each year of college education.

• Certified Coding Certification, or the ability to obtain it within 24 months of employment.

• At least 3 years of experience in claims processing operations and reporting systems.

• A minimum of 2 years of experience in auditing or developing reports for computer systems.

• Understanding of accreditation standards, including URAC and NCQA.

• Familiarity with health insurance legislation.

• Knowledge of claims processes and claims processing systems.

• Proficient in PC skills, including Microsoft Word, Excel, and health insurance databases.

• Strong verbal and written communication skills to interact with physicians, members, and providers while explaining documented findings.

• Excellent organizational and prioritization abilities.

• Current AAPC Medical Coding Certification is preferred.

🏝️ Benefits

• Tailored development plans and investment in professional growth.

• Comprehensive health and wellness benefits.

• 401(k) retirement savings plan.

• Pension plan.

• Paid time off.

• Paid parental leave.

• Disability insurance.

• Supplemental life insurance.

• Employee assistance program.

• Paid holidays.

• Tuition reimbursement.

• Performance incentives.

• Annual incentive bonus plan.