Investigative Analyst

Health Care Service Corporation
United States, Texas, Richardson
1001 East Lookout Drive (Show on map)
Nov 08, 2024
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 This position is responsible for planning and conducting investigations and audits of potentially abusive/aberrant billing practices and other provider/member issues; identifying and resolving internal issues, tracking the data and potentially coordinating with other areas of the corporation in an effort to improve future outcomes; planning and coordinating the activities of Provider Claims Analyst in support of potential investigations and audits; Utilizing existing database information to identify patterns of abusive/aberrant billing practices by both our provider and member community; and recommending system and internal control enhancements to reduce the potential for adjudication errors. Required Job Qualifications: Bachelor's degree from an accredited college AND 2 years of general knowledge of claims processing operations and contract and benefit administration, financial control procedures, and statistics OR 6 years of health care investigative experience, including exposure to one or more of the following functional areas: claims processing operations; contract administration; claims coding; and/ or finance and accounting, OR law enforcement experience Clear, concise communication skills, and strong analytical and quantitative skills. Experience with the Microsoft Office 365 product suite, with an emphasis on Excel and Access. Analytical and quantitative skills Preferred Job Qualifications: Knowledge of medical practice patterns. Experience working in a financial, accounting, criminal justice, or legal environment. Exposure to programming languages, such as SQL. Certified Coder Investigative Accreditation (AHFI, or CFE) Knowledge of Medicare Please note that this role is HYBRID with an in-office requirement of 3 days a week #LI-Hybrid Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! HCSC Employment Statement: We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, 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$43,900.00 - $97,700.00