Description
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.
This position is responsible for system pricing development, supporting functions needed for contract financial analysis and performance. The individual in this role manages the coordination of internal/external audit requests, performs routine and ad hoc reporting, and maintains an understanding of provider contracts. Responsibilities include but are not limited to summarizing monthly HMO cap results by Provider Organization and research extreme membership fluctuations, maintaining HMO Risk tables, reviewing non-standard contracts for system capability, representing Provider Contract Management in internal/external audits, including Model Audit Rule (MAR) and SOC-1 audits, providing documentation for these audits are requested, and serving as technical expert on assigned subject areas.Required Job Qualifications:
- Bachelor Degree in Finance, Accounting or Math with 6 years experience in the Health Care Industry OR 8 years experience.
- 6 years experience in interpreting provider contracts and system requirements.
- 6 years experience in a managed care healthcare environment.
- 5 years experience in one or more of the following or similar claims adjudication and pricing systems: Blue Chip, MHS or HMO systems.
- Knowledge of CPT, HCPCS, ICD10, Revenue code and/or DRG coding practices, Relative Value Unit, Anesthesia, Durable Medical, and other methodology in support of current and future pricing scenarios.
- Flexibility to meet deadlines in an environment of constantly changing priorities and workloads.
- Leadership, analytical, problem-solving, organizational and communication skills.
- PC proficiency to include all Microsoft products.
Preferred Job Qualifications:
- FACETS Claims Application experience is strongly preferred
- Teradata/SQL queries
- AGILE method of IT project development along with Optimized Waterfall.
This is a Flex (Hybrid) role: 3 days in office; 2 days remote.
Sponsorship is not available.
#LI-Hybrid
Compensation: $60,300.00 - $133,400.00
Exact compensation may vary based on skills, experience, and location
HCSC Employment Statement:
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are 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.
To learn more about available benefits, please click https://careers.hcsc.com/totalrewards
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