Job ID: FIW-1041975
This position is located in the Albuquerque Headquarters
Looking for candidates with experience in Claims Processing,
Auditing and Coding.
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
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
- 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
- PC proficiency to include Microsoft Word and Excel and health
- 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 REQUIREMENTS:
- Registered Nurse (RN) with unrestricted license in state.
- 3 years clinical experience.
- Coding experience.
Relocation assistance will not be provided for this
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