Coding Investigator Auditor - Remote

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• Job Summary
• The Coding Investigator Auditor role is responsible for conducting billing, coding, and documentation reviews of professional and outpatient claims for services in both a pre and post payment environment to validate the accuracy and adherence specific to ICD-10-CM, CPT, HCPCS and CMS coding guidelines, specific to unbundling, duplicate billing, upcoding, misuse of modifiers, violation of provider contract, medical policy adherence.

Operational efficiency with coding guidelines, internal and internal policies, provider contracts, state regulations and other information to validate the claims submitted and billed. In addition, this role is responsible for conducting research, preparing documentation and communication of findings, and consulting with internal departments and staff as needed.

• Required Job Qualifications:

• + Bachelor's Degree; in lieu of degree one year of claims or coding experience, may substitute for each year of college.

+ Certified Coding Certification (CPC, COC, CCS, CCS-P, RHIT, RHIA) 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. + Adhere to time management, production and quality standards as set by the department. + Professional communication skills, oral and written. + Prioritize multiple assignments and multiple spreadsheets, documents, and reports. + Industry knowledge of Medicare regulations and payment policies, including OPPS + Proficient in computer applications such as Microsoft Excel, Teams, PowerPoint, Word, and Outlook

• Preferred Job Qualifications:

• + 2+ years certified coding experience
• This role will be 100% work from home
• \#LI-LK1 \#LI-Hybrid
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• Pay Transparency Statement:

• At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work.

From 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, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards . The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

• HCSC Employment Statement:

• We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are 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.

• Base Pay Range
• $55,900.00 - $123,500.00 Exact compensation may vary based on skills, experience, and location.
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• For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families.

As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren't afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you'll have to improve health care delivery in an open, collaborative environment. HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants. 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 call us at 1-866-977-7378 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 "candidate home" to view your job submissions. Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas, Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2025 Health Care Service Corporation. All Rights Reserved.