Coding Investigator

Job ID: HF-1018893 Description:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants.We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can email us here to request reasonable accommodations.

Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "my account" and click on "View your job submissions".

Basic Function:

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:

  • Registered Nurse (RN) with unrestricted license in state.
  • 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 Job Qualifications:

  • 3 years clinical experience OR 3 years' experience as Certified Facility Coder.

Position is located in Helena, MT.

LI-POST

  • CA
  • CB

Requirements: Expertise Claims & Customer Service Job Type Full-Time Regular Location MT - Helena


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