Coding Investigator Auditor

This is a fully remote position, open to applicants in Illinois, +4 more states.

📋 Description

• Perform audits on clinical, billing, coding, and reviews of the lowest-cost settings for services both pre- and post-payment.

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

• Engage in research activities.

• Document findings thoroughly.

• Collaborate with special investigation and affordability of care teams as necessary.

• Coordinate efforts with the medical director, special investigations, customer service, PASS, network management, marketing, case management, medical review, legal, pricing, and database departments.

⛳️ Requirements

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

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

• A minimum of 3 years of experience in claims processing operations and reporting systems, including at least 2 years in auditing or developing computer system reports.

• Familiarity with accreditation standards, such as URAC and NCQA, as well as health insurance legislation.

• Understanding of claims processes and claims processing systems.

• Proficiency in PC applications, including Microsoft Word, Excel, and health insurance databases.

• Strong verbal and written communication skills for effective interaction with physicians, members, and providers, as well as for composing and explaining documented findings.

• Excellent organizational and prioritization skills.

• Current AAPC Medical Coding Certification is preferred.

• Must be capable of working remotely within the continental United States, excluding California, New York, Alaska, and Hawaii.

🏝️ Benefits

• 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 incentives.

• Opportunities for professional development.

• Remote work arrangement.