Coding Investigator Auditor - Work From Home (Healthcare)

Location: Remote within the United States; position associated with Chicago, Illinois

Base pay: $55,900.00–$123,500.00 annually, plus eligibility for an annual incentive bonus.

Company

Health insurance organization providing claims, medical review, affordability, and related healthcare services.

What you will do

• Audit clinical, billing, coding, and lowest-cost-setting reviews for services before and after payment.
• Use medical, contractual, legislative, policy, and other information to validate submitted claims.
• Research cases and prepare clear documentation of audit findings.
• Consult with special investigations and affordability-of-care functions as needed.
• Coordinate case reviews 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.
• Certified Coding Certification, or the ability to obtain it within 24 months of hire.
• Three years of experience in claims processing operations and reporting systems, including two years auditing or developing computer system reports.
• Knowledge of URAC and NCQA accreditation standards and health insurance legislation.
• Awareness of claims processes and claims processing systems.
• Proficiency with Microsoft Word, Excel, health insurance databases, written communication, organization, and prioritization.

Nice to have

• Current AAPC Medical Coding Certification.

Culture & Benefits

• Work-from-home arrangement.
• Curated development plans supporting professional growth.
• Health and wellness benefits, 401(k) savings plan, and pension plan.
• Paid time off, paid parental leave, paid holidays, disability insurance, and supplemental life insurance.
• Employee assistance program and tuition reimbursement.