Clinical Coding RN Lead | ICD-10, QA & Training

Blue Shield of CA; Houston (TX); Hybrid; USD 120,000 - 170,000; Full time

Benefits offered by this job

Hybrid work model

Leadership development opportunities

Job summary

Blue Shield of CA is seeking a Clinical Coding Analyst RN, Consultant to lead the Facility Compliance Review team, overseeing post-service facility claim reviews for contract compliance, medical necessity and DRG accuracy.

The role includes mentoring a two-person coder team, performing quality audits, and ensuring correct reimbursement. A California RN license, CPC/CCS certification preferred, and strong EHR and data analytics skills are required.

Qualifications

• Requires Associate's degree in nursing (RN).
• California RN license with ability to obtain license in assigned states.
• 7+ years of relevant experience in clinical coding and review.
• 3+ years inpatient coding experience required.
• Certification: CCS, CPC-CIC, RHIT, RHIA, CCDS, or CDIP preferred.
• UM experience and claim data analytics skills required.

Responsibilities

• Lead claims reviews for ICD-10-CM/PCS coding, EDC, MS-DRG, and APC reviews.
• Mentor and train a small clinical coding team of 2 coders.
• Conduct quality audits of hospital claims to ensure accurate reimbursement.
• Review outpatient coding for appropriate billing of injections and infusions.
• Provide leadership and training to the team, supporting continuous learning.

Skills

Leadership experience

Data analysis

EHR familiarity

Independent motivation

Attention to detail

Education

Associate's degree in nursing

California RN license

Tools

Oracle (Cerner)

Job description

Blue Shield of CA is seeking a Clinical Coding Analyst RN, Consultant to lead the Facility Compliance Review team, overseeing post-service facility claim reviews for contract compliance, medical necessity and DRG accuracy.

The role includes mentoring a two-person coder team, performing quality audits, and ensuring correct reimbursement. A California RN license, CPC/CCS certification preferred, and strong EHR and data analytics skills are required.