Coding Investigator Auditor (Work From Home)

HCSC•Richardson, TX

36d•Remote

About The Position

This position is responsible for performing Reimbursement Policy (RP) review, creation and publication. Conducting research; preparing documentation of findings as needed. Coordination with all departments involved in each project required such as Special Investigations, Customer Service, Pass, Network Management, Marketing, Case Management, Medical Review, Legal, Pricing And Database. Perform annual review of policies which includes research and providing updates to coding and suggested language changes. Support completion of annual reviews and approvals including recording votes, feedback.

Requirements

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.

Nice To Haves

Certified Coding Certification - HIGHLY PREFERRED
Clear and consistent post-meeting summarization and professional communication/presentation skills.
Familiar with AP Style (Associated Press): Standard for journalism and public relations, focusing on brevity, consistent spelling, and abbreviations.
Experience leading annual audit of policy utilization and charter update, to include policy improvement, voting roster, etc.
Support and create policy summaries.

Responsibilities

Perform Reimbursement Policy (RP) review, creation and publication.
Conduct research and prepare documentation of findings.
Coordinate with various departments including Special Investigations, Customer Service, Pass, Network Management, Marketing, Case Management, Medical Review, Legal, Pricing, and Database.
Perform annual review of policies, including research and providing updates to coding and suggested language changes.
Support completion of annual reviews and approvals, including recording votes and feedback.
Support CWG (Coding Work Group) and other policy related meetings.
Perform routine auditing.
Audit/review RP sites to ensure the accuracy/timing of the posted policies.
Work with Corp Comms on ideas/ solutions for process improvement.