Coding Investigator Auditor

Role Overview

• performing Reimbursement Policy (RP) review, creation and publication
• conducting research; preparing documentation of findings as needed
• coordination with all departments involved in each project
• performing annual review of policies which includes research and providing updates to coding and suggested language changes
• supporting completion of annual reviews and approvals including recording votes, feedback

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

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
• other incentives