At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

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. Conducting Research; Preparing Documentation Of Findings And 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.

Required Job Qualifications:

• 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.
• REMOTE WORK

Preferred Job Qualifications:

• Registered Nurse (RN) with unrestricted license in state.
• 3 years clinical experience.

*CA

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HCSC Employment Statement:

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, 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.