Coding Investigator Auditor - Work From Home (Healthcare)

Location: Remote within the continental United States, excluding California, New York, Alaska, and Hawaii

Base pay: $63,300–$114,300 annually

Company

hirify.global provides health insurance services and supports claims, clinical review, and healthcare affordability operations.

What you will do

• Audit clinical, billing, coding, and lowest-cost-setting reviews before and after payment.
• Use medical, contractual, legislative, policy, and related information to validate submitted claims.
• Research cases and prepare clear documentation of audit findings.
• Consult with special investigations and healthcare affordability functions as needed.
• Coordinate cases with medical directors, customer service, network management, legal, pricing, database, and other departments.

Requirements

• Bachelor’s degree; one year of business, law enforcement, or regulatory agency experience may substitute for each year of college.
• Three years of claims processing operations and reporting systems experience, including two years auditing or developing computer system reports.
• Certified Coding Certification, or ability to obtain it within 24 months of hire.
• Knowledge of URAC and NCQA accreditation standards and health insurance legislation.
• Understanding of claims processes and claims processing systems.
• Proficiency with Microsoft Word, Microsoft Excel, health insurance databases, written communication, and organizational prioritization.

Nice to have

• Current AAPC Medical Coding Certification.

Culture & Benefits

• Remote work within the eligible continental United States.
• Curated development plans and professional development support.
• Health and wellness benefits, 401(k) savings plan, and pension plan.
• Paid time off, parental leave, holidays, disability insurance, life insurance, and employee assistance support.
• Tuition reimbursement and eligibility for an annual incentive bonus plan.