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Health Information Specialist
4 months ago
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future
Job Summary
This position is responsible for the quality and efficiency of the clinical quality review process associated with the CMS HHS_RADV (Risk Audit Data Validation) program for ACA plans and HEDIS (Healthcare Effectiveness Data and Information Set). Analysts are responsible for ensuring a successful audit including verifying provider information, medical record retrieval, conducting medical chart reviews on encounters and validating HCC's which have been submitted via claims data, identifying erroneous data and initiate corrections needed, submitting the final audited record to the coding team, and tracking the entire process.
REQUIRED JOB QUALIFICATIONS:
* Bachelor's degree and 2 years' experience auditing claims, inquiry or experience in the health insurance industry OR 6 years' experience auditing claims, inquiry, or membership within the health insurance industry.
* Knowledge of contract administration, and medical terminology.
* Analytical and research skills.
* Clear and concise written and verbal communication skills.
* Organizational and multi-tasking skills to manage daily workload and meet aggressive deadlines and timetables.
* Knowledge of state contract provisions.
* PC proficiency to include Word, Excel, PowerPoint, Microsoft Teams, and WebEx
* Experience meeting deadlines.
PREFERRED JOB QUALIFICATIONS:
* RADV, HEDIS or HCC auditing experience
* LPN or MA licensure or certification
* Certified Coder
* Quality audit experience
#LI - Hybrid
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HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a 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, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
