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.

Summary: This position is responsible for performing billing and coding reviews for pre-payment services 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. Cross training to support multi lines of business as needed. *** Note: Candidates must have medical coding certification from AAPC or AHIMA upon hire. This is a full-time non-clinical telecommuter position. ***

Required Job Qualifications:

• Bachelor Degree; 1 year of business experience, or 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.

Preferred Experience:

• Experience with inpatient medical coding

• Medical coding certification from AAPC or AHIMA

This is a Telecommute opportunity. Must have a permanent residential address within the listed state lines.

Sponsorship will not be provided for this role.

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.