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HCSC

Offers health insurance and wellness programs

Pricing Coordinator

Claims AdjudicationConfirmed live in the last 24 hours
Full-timeAlbuquerque, NM, USA

About the Job

Requirements

  • A bachelor's degree in Math, Statistics, or Computer Science, or four years of experience in the healthcare industry.
  • One year of experience with databases such as Access and spreadsheets such as Excel.
  • One year of experience in a position requiring data analysis.
  • Knowledge of healthcare finance and reimbursement methodologies, including provider contract execution.
  • Verbal and written communication skills.
  • Math skills.
  • Ability to work independently and meet deadlines.

Responsibilities

  • Provide technical direction on defining and implementing provider reimbursement rates based on Centers for Medicare & Medicaid Services Medicare methodologies, primarily in Part B programs.
  • Monitor the structure of and changes to Medicare Part B pricing procedures and evaluate their impact on Indian Health Service fiscal intermediary processes.
  • Inform management of implications and make recommendations as appropriate.
  • Obtain current Medicare rates, work with systems to have them loaded, and/or distribute the information to staff for pricing.

Desired Qualifications

  • Familiarity with research techniques.
  • Knowledge of Medicare and Medicaid reimbursement methodologies, private insurance reimbursement, claims processing concepts, and medical classification coding systems.
  • Experience developing and evaluating reimbursement methodologies.
  • Experience with PC, mainframe applications, and encoding systems.
  • Claims processing experience.

About the Company

HCSC

Offers health insurance and wellness programs

HCSC is a health insurance provider active in Illinois, Montana, New Mexico, Oklahoma, and Texas. It sells health insurance plans to individuals, families, and businesses, funding its services through member premiums. The company works by offering a range of plans tailored to different needs and by investing in wellness programs and care initiatives aimed at improving member health and reducing overall costs. Compared with others, HCSC emphasizes its long history, broad regional footprint, and its focus on quality care, cost management, and wellness-driven outcomes, distinguishing itself through sustained service and programs that support healthier living. Its goal is to help people live healthier lives by delivering reliable coverage, improving member outcomes, and controlling healthcare costs.

Company size
Not listed
Company stage
Not listed
Total funding
$511.7M
Headquarters
Chicago, IL
Founded
1936

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