Coding Specialist

Blue Cross and Blue Shield of North Carolina

North Carolina

Hybrid

USD 46,000 - 73,000

Full time

5 days ago

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Benefits offered by this job

Work-life balance

Medical, dental, and vision coverage

Parental leave and adoption support

Tuition reimbursement

Job summary

Blue Cross NC is seeking a Coding Specialist to analyze medical records and provider coding using clinical expertise. You will report CMS-relevant data and ensure compliance with HCC payment methodologies. Build relationships with medical providers for on-site reviews and maintain audit-ready documentation.

The role emphasizes independent work in a fast-paced environment with focus on accuracy and compliance, within a Hybrid Flex setting across multiple states.

Qualifications

Certified Professional Coder credential.
Experience reviewing and assigning medical codes in health insurance or reimbursement environments.
Strong understanding of ED/ER coding and medical claim review processes.
Ability to work independently with high productivity and accuracy.

Responsibilities

Analyze documentation and apply clinical coding expertise to evaluate provider coding accuracy.
Report relevant data to CMS.
Maintain documentation for audit results and review status.

Skills

Certified Professional Coder

Medical coding experience

Emergency Department coding

Independent work

Education

High school diploma or GED

Job description

Job Description

The Coding Specialist will use clinical and coding expertise to analyze medical records and charts in relation to provider coding. You will identify physician practices with complex coding patterns and report relevant data to the Centers for Medicare and Medicaid Services (CMS).

What You'll Do

Analyzes necessary documentation, including medical records/charts, and applies clinical coding expertise to evaluate appropriateness of provider coding and reports relevant data to the Centers for Medicare and Medicaid Services (CMS). Uses all resources to ensure compliance and understanding of the CMS Hierarchical Condition Category (HCC) payment methodology. Develops and maintains professional working relationships with Medical Providers and their staff necessary to facilitate onsite review of medical records. Maintains documents for tracking audit results, status of reviews etc.

What You Have

High school diploma or GED 3+ years of experience in related field.
Certified Professional Coder.
Bonus Points Experience reviewing and assigning medical codes, preferably in a health insurance, claims, payment integrity, or reimbursement environment.
Strong understanding of Emergency Department (ED/ER) coding and medical claim review processes.
Ability to work independently while maintaining high levels of productivity and accuracy.
Demonstrated success in a fast-paced, production-oriented environment and adaptability to continuous change.
Experience working under quality review standards with a focus on accuracy and compliance.

What You’ll Get

The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
Work-life balance, flexibility, and the autonomy to do great work
Medical, dental, and vision coverage along with numerous health and wellness programs
Parental leave and support plus adoption and surrogacy assistance
Career development programs and tuition reimbursement for continued education
401k match including an annual company contribution

Learn more

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $45,761.00 - $73,217.00

About Us

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We're committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well‑being of North Carolinians. Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all. Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview for English or Visión General de E-Verify for Español.

Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at HR.Staffing@bcbsnc.com.

Hybrid Flex Company

Blue Cross NC is a Hybrid Flex company. Whether the role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any of our approved states: