Job SummaryThis position is responsible for 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 and 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.Required Job Qualifications: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 hire3 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 skillsPreferred Job Qualifications:Current AAPC Medical Coding CertificationHCSC Employment Statement:We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.Base Pay Range$55,900.00 - $123,500.00Exact compensation may vary based on skills, experience, and location.