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.

Job Summary

Summary:
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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Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

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.