Coding Specialist

bcbsnc; United States; On-site; USD 46,000 - 73,000; Full time

Job summary

Blue Cross NC is seeking a qualified medical coder to analyze documentation and apply coding expertise to evaluate provider coding for CMS reporting.

You will use CMS HCC guidelines, collaborate with medical staff, and maintain audit records while ensuring accuracy and compliance in a fast-paced environment.

The role offers growth opportunities, comprehensive benefits, and a supportive team focused on quality and community health.

Qualifications

• High school diploma or GED required.
• At least 3 years of related field experience.
• Certified Professional Coder credential required.

Responsibilities

• Analyzes documentation and applies clinical coding to evaluate provider coding for CMS reporting.
• Uses CMS Hierarchical Condition Category (HCC) guidelines to ensure accurate coding.
• Maintains relationships with medical providers and staff to facilitate on-site review of records.
• Keeps audit tracking documents up to date and organized.

Skills

Experience in related field

Education

High school diploma or GED

Certified Professional Coder

Job description

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 a daptability 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

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