Coding Compliance Specialist

Posted 3 Days Ago
Be an Early Applicant
Albuquerque, NM
41K-91K Annually
Junior
Healthtech • Insurance
The Role
The Coding Compliance Specialist is responsible for researching and analyzing medical records for coding discrepancies. This includes auditing records for compliance with coding procedures, validating coding, reviewing insurance payments and denials, and recommending corrections. The role requires some travel (20-30%) in and out of state.
Summary Generated by Built In

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

Under supervision, this position is responsible for researching and analyzing the medical records when there is a discrepancy in coding. Validating the coding and supporting the department in the reporting of findings. This position audits medical records to ensure compliance with the organizations coding procedures and standards according to the CMS coding guidelines and official ICD9 / ICD10 coding guidelines. Reviews insurance payments and denials and recommends coding corrections.
Ability to travel 20 – 30% of the time in and out of state.

Job Requirements:

  • High School Diploma or GED.
  • CPC Coding Certification/CPC, CCS, CCSP.
  • 2 years medical coding experience.
  • Experience with process management.
  • PC experience and skills to include Microsoft Office
  • Verbal and written communication skills.
  • Analytical skills.

Preferred Job Requirements:

  • Associate or Bachelor’s degree.
  • CRC.
  • Experience in health insurance or health care setting.
  • Previous experience working on Risk Adjustment coding for either Medicare Advantage or Retail Exchange business.

This is a Telecommute (Remote). Must reside within 250 miles of the office or anywhere within the posted state.

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 / 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$40,900.00 - $91,000.00

The Company
HQ: Chicago, IL
13,563 Employees
On-site Workplace

What We Do

Imagine Something New, Something Different.

Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), is the largest customer-owned health insurer in the nation and the fourth largest overall. Operating through our Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas (as well as a variety of affiliates and subsidiaries,) we are expanding access to high-quality, cost-effective health care. We are equipping members with information and tools so they can make the best health care decisions for themselves and their families.

HCSC is continuously recognized as an employer committed to community, diversity and inclusion, training and development.

HCSC is committed to pioneering the health care space in ways as effective as they are creative. If you are passionate about the impact you want to have through your work, with a desire to apply innovative thinking to new and emerging challenges, we encourage you to learn more about HCSC.

Learn about what we stand for, how we work and the difference we’re making in the lives of our 15 million members. Join HCSC and discover what new ways of thinking can mean for you, your community, our customers and our organization.



Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.

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