Clinical Coding Lead RN - ICD/DRG Audits (Hybrid)

Blue Shield of CA; Las Vegas (NV); Hybrid; USD 90,000 - 130,000; Full time

Job summary

Blue Shield of CA is seeking a Clinical Coding Analyst RN, Consultant to support the Facility Compliance Review team in Las Vegas. The role leads a small coder group, reviews ICD-10 codes, MS-DRG/APR-DRG, and medical necessity for post-service prepayment facility claims.

The ideal candidate holds an AHIMA/AAPC certification, 7+ years in the field, and strong leadership with experience in EHR systems and UM. Hybrid work with early PST schedules is offered.

Qualifications

• Associate's degree in nursing required or equivalent.
• California RN license or eligible state license with CA reciprocity within 90 days.
• 7 years of relevant experience and 3 years inpatient coding.
• ACRS certifications CCS/CPC-CIC/RHIT/RHIA/CCDS/CDIP required or higher.
• UM experience and ability to analyze claim data analytics.
• Health plan experience preferred and strong computer skills.

Responsibilities

• Lead and train a small clinical coder team; review claims for ICD-10-CM/PCS coding.
• Ensure compliance with hospital billing standards, medical necessity, and DRG/APC reviews.
• Perform audits of outpatient coding related to injections/infusions.
• Provide guidance to staff and act as a resource for coding questions.
• Collaborate with senior manager to drive quality and accuracy.

Skills

Leadership

Attention to detail

Data analysis

Independent motivation

Communication

Education

Associate's degree in nursing

Tools

Cerner EHR

EM leveling

Job description

Blue Shield of CA is seeking a Clinical Coding Analyst RN, Consultant to support the Facility Compliance Review team in Las Vegas. The role leads a small coder group, reviews ICD-10 codes, MS-DRG/APR-DRG, and medical necessity for post-service prepayment facility claims.

The ideal candidate holds an AHIMA/AAPC certification, 7+ years in the field, and strong leadership with experience in EHR systems and UM. Hybrid work with early PST schedules is offered.