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Company: HCSC
Location: albuquerque
Posted on: May 3, 2021

Job Description:

Job ID: FIW-1041975


This position is located in the Albuquerque Headquarters office

Looking for candidates with experience in Claims Processing,

Auditing and Coding.

Job Purpose:

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.


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


  • CA

Relocation assistance will not be provided for this position.

Sponsorship will not be provided for this position.

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.


Expertise Audit, Quality Assurance, Regulatory & Compliance Job Type Full-Time Regular Location NM - Albuquerque

Keywords: HCSC, Albuquerque , Investigator, Other , albuquerque, New Mexico

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