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Blue Cross and Blue Shield of Illinois, Montana, N Coding Investigator Auditor in Helena, Montana


Job Purpose: This position is responsible for performing clinical, billing, coding and lowest cost setting reviews for services pre and post payment utilizing medical, contractual, legislative, policy, and other information to validate claims submitted and billed; conducting research; preparing documentation of findings and consulting with Medical Directors as needed Coordination with all departments involved in each case required such as Special Investigations, Customer Service, PASS, Network Management, Marketing, Case Management, Medical Review, Legal, Pricing and Database.Required

Job Qualifications: * Registered Nurse (RN) with unrestricted license in state.* 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: * 3 years clinical experience OR 3 years* experience as Certified Facility Coder

  • Salary requirements: $60,600 + depending on experience #CA #LI-DP1

    Location: MT - Helena

    Activation Date: Wednesday, October 6, 2021

    Expiration Date: Saturday, January 1, 2022

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