Coding Investigator Auditor - Oklahoma

HCSC•Tulsa, OK

10d•Hybrid

About The Position

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 be conducting research; preparing documentation of findings and consulting with medical directors as needed. Additional duties include 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.

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

Active Certified Professional Coder (CPC) certification, offered by the AAPC.
3 years clinical experience

Responsibilities

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.
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.