At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
This position is responsible for performing Reimbursement Policy (RP) review, creation and publication. Conducting research; preparing documentation of findings as needed. Coordination with all departments involved in each project required such as Special Investigations, Customer Service, Pass, Network Management, Marketing, Case Management, Medical Review, Legal, Pricing And Database. Perform annual review of policies which includes research and providing updates to coding and suggested language changes. Support completion of annual reviews and approvals including recording votes, feedback.
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
Preferred Job Qualifications:
Certified Coding Certification - HIGHLY PREFERRED
Support CWG (Coding Work Group) and other policy related meetings.
Clear and consistent post-meeting summarization and professional communication/presentation skills.
Familiar with AP Style (Associated Press): Standard for journalism and public relations, focusing on brevity, consistent spelling, and abbreviations
Experience leading annual audit of policy utilization and charter update, to include policy improvement, voting roster, etc.
Support and create policy summaries
Perform routine auditing
Audit/review Plan RP sites to ensure the accuracy/timing of the posted policies
Work with Corp Comms on ideas/ solutions for process improvement
Sponsorship will not be provided for this role.
This position is Telecommute (Work From Home).
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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.
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.
$55,900.00 - $123,500.00
Exact compensation may vary based on skills, experience, and location.
Health Care Service Corporation serves nearly 23 million people across the United States through its portfolio of health benefit solutions.
HCSC provides health coverage options for employers large and small, individuals and families, and Medicare and Medicaid plans. HCSC also offers related health care products and services such as pharmacy solutions, life and dental insurance, and health data technology. A Mutual Legal Reserve Company, HCSC is an independent licensee of the Blue Cross Blue Shield Association.
For nearly a century, we have enabled and coordinated the access to quality care for millions of members. Our experience and industry knowledge establishes a solid foundation for our future—driving innovations that further expand access, improve health outcomes, and reduce costs.
Embedded within the fabric of how we operate is a deep sense of caring and commitment that informs how we serve our members, engage in local communities, and deliver positive change to the health care industry.
As health care needs evolve, we leverage our portfolio of companies to deliver differentiated value to all industry stakeholders so that, together, we make more possible.
Join HCSC and discover what new ways of thinking can mean for you, your community, our customers and our organization: HCSC.com/careers. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to an inclusive, 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, gender, national origin, disability, or protected veteran status.
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