Audit Specialist II

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 The Audit Specialist Analyst II is responsible for independently executing internal and external audits, interpreting audit findings, validating compliance with contractual performance guarantees, and supporting broader quality assurance initiatives. This role requires advanced knowledge of Affordable Care Act, Commercial, Medicare and Medicaid reimbursement methodologies, including facility, ancillary, and professional claims, as well as the ability to analyze claim calculations, interpret provider contracts, collaborate with cross-functional teams, and identify opportunities to improve audit accuracy, compliance, and operational performance. Required Job Qualifications: Bachelor’s degree or equivalent experience in claims processing or audit. 2 years in audit or claims review. Familiarity with adjudication systems. Proficient in Microsoft Office and audit software. Strong analytical and communication skills. Preferred Job Qualifications: Experience in payment integrity or provider contracting – HIGHLY PREFERRED Extensive experience across ACA, Commercial, Medicare, and Medicaid plans, including reimbursement methodologies and payment structures Strong expertise in facility, ancillary, and professional billing, coding, and reimbursement practices Proven ability to interpret provider contracts and perform detailed claim reviews, calculations, and variance analysis Advanced analytical, critical thinking, and problem-solving skills to assess risks and recommend corrective actions Excellent communication and collaboration skills, with the ability to present findings, manage priorities independently, and partner effectively across stakeholders Sponsorship will not be provided for this role. This is a Telecommute (Remote) role. #LI-LI1 #LI-Remote 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 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. Base Pay Range $41,700.00 - $92,800.00 Exact compensation may vary based on skills, experience, and location.