Clinical Coding Lead RN – ICD-10 & DRG Audits (Hybrid)

Blue Shield of CA; Chicago (IL); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Blue Shield of CA is seeking a Clinical Coding Analyst RN, Consultant to lead the Facility Compliance Review team. You will review claims, perform coding analyses, and ensure medical necessity and accurate DRG/APC assignments while training others.

This hybrid role requires leadership experience, ESR/UM background, and active coding certifications. The position involves mentoring two coders, and coordinating with the Senior Manager for quality improvements and staff development.

Qualifications

• Associate's degree in nursing is required.
• California RN license required or eligible; must obtain CA license within 90 days if assigned other state.
• 7 years of relevant experience; 3 years inpatient coding.
• Certifications: CCS, CPC-CIC, RHIT, RHIA, CCDS or CDIP.
• Utilization management (UM) experience required.
• Health plan/managed care experience preferred.
• Strong attention to detail; independent motivation; strong computer navigation skills.
• Familiarity with EHR systems, Oracle (Cerner) and ED EM leveling experience preferred.

Responsibilities

• Lead capacity reviewing claims and training new hires; facilitate refresher trainings for the team.
• Support the FCR team in reviewing post-service prepayment facility claims.
• Mentor and be a resource for the clinical coders and staff.
• Review outpatient coding for billing accuracy and medical necessity.

Skills

Leadership

Claim analytics

Healthcare billing

Attention to detail

Independent motivation

Computer navigation

EHR familiarity

Team leadership

Education

Associate's degree in nursing

Tools

Cerner Oracle

EHR systems

EDM leveling experience

Job description

Blue Shield of CA is seeking a Clinical Coding Analyst RN, Consultant to lead the Facility Compliance Review team. You will review claims, perform coding analyses, and ensure medical necessity and accurate DRG/APC assignments while training others.

This hybrid role requires leadership experience, ESR/UM background, and active coding certifications. The position involves mentoring two coders, and coordinating with the Senior Manager for quality improvements and staff development.