Clinical Coding Lead RN – Facility Compliance (Hybrid)

Blue Shield of CA; Baltimore (MD); Hybrid; USD 90,000 - 130,000; Full time

Job summary

Blue Shield of CA seeks a Clinical Coding Analyst RN, Consultant to support the Facility Compliance Review team. You will lead quality audits on hospital claims, mentor two clinicians, and review ICD-10-CM/PCS codes for accuracy and compliance.

The role requires nursing, active CA RN license or applicable state license, and CCS/CPC/RHIT/RHIA etc. certifications. Hybrid work with initial PST hours is offered.

Qualifications

• Associate's degree in nursing required.
• California RN license or license in assigned state required; CA license within 90 days if assigned.
• 7 years of relevant experience and 3 years inpatient coding experience required.
• Certified Coding Specialist (CCS), CPC-CIC, RHIT, RHIA, CCDS or CDIP certificates required or highly desirable.
• Utilization management (UM) experience required; strong data analytics skills.
• Health plan experience preferred; familiarity with EHRs and Oracle (Cerner).

Responsibilities

• Lead capacity for reviewing claims and coding quality audits.
• Review medical records and perform ICD-10-CM/PCS, DRG/APC analyses.
• Train new hires and facilitate refresher trainings for the team.
• Act as a resource for the coding team to answer questions and ensure proper billing.
• Ensure outpatient coding aligns with reimbursement requirements and clinical data.

Skills

CPC

CCS

RHIT

RHIA

CDDS

CDIP

Education

Associate's degree in nursing

California RN License (unrestricted) or state license

Tools

Oracle Cerner

Job description

Blue Shield of CA seeks a Clinical Coding Analyst RN, Consultant to support the Facility Compliance Review team. You will lead quality audits on hospital claims, mentor two clinicians, and review ICD-10-CM/PCS codes for accuracy and compliance.

The role requires nursing, active CA RN license or applicable state license, and CCS/CPC/RHIT/RHIA etc. certifications. Hybrid work with initial PST hours is offered.