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 role 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 degree and 2 years' experience auditing claims, inquiry or membership within the health insurance industry OR 6 years' experience auditing claims, inquiry or membership within the health insurance industry.

　　Knowledge of the various Blue Chip processing systems (i.e., BlueSTAR, CFE, etc.) 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 work load and meet aggressive deadlines and timetables.

　　Knowledge of state contract provisions.

　　Knowledge with sold case materials, departmental documents.

　　PC proficiency to include Word, Excel, PowerPoint, EPPS, NICE, Live Meeting/WebEx and Lotus Notes.

　　Experience meeting deadlines.

　　Preferred Job Qualifications:

　　Clinical background

　　Ability to read and interpret a medical record

　　Quality audit experience

　　Knowledge of health insurance products

　　Ability to use ICD - 10

　　We encourage people of all backgrounds and

　　experiences to apply. Even if you don't think you are a perfect fit, apply

　　anyway - you might have qualifications we haven't even thought of yet.

　　#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:

　　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.