Investigator Jobs in Chicago, IL

About The Position

Requirements

• Bachelor’s 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 of experience in claims processing operations and reporting systems, including 2 years of 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

• Current AAPC Medical Coding Certification

Responsibilities

• Auditing 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 special investigation and the affordability of care area as needed.
• Coordinating with all departments involved in each case required such as medical director special investigations, customer service, pass, network management, marketing, case management, medical review, legal, pricing and database.

Benefits

• 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
• annual incentive bonus plan