Hybrid Lead Clinical Coding RN – Compliance & Audits

Blue Shield of CA; Oakland (CA); Hybrid; USD 110,000 - 150,000; Full time

Job summary

Blue Shield of CA is seeking a Clinical Coding Analyst RN, Consultant to lead a small coding team and review facility claims for ICD-10-CM/PCS coding accuracy. You will support quality audits, financial and care‑delivery improvement while staying compliant with payer rules.

The role requires an RN license in California, 7 years of relevant experience, and advanced coding certifications. A hybrid work arrangement and leadership development are offered.

Qualifications

• Associate's degree in nursing is required.
• Current unrestricted California RN License and/or in assigned states.
• 7 years of prior relevant experience required.
• 3 years' inpatient coding experience required.
• Certification: CCS, CPC-CIC, RHIT, RHIA, CCDS or CDIP.
• Utilization management (UM) experience is required.
• Health plan experience (managed care) preferred.
• Familiarity with EHR systems, Cerner/Oracle preferred.

Responsibilities

• Lead a clinical coding team and assist with reviews of post‑service facility claims.
• Perform coding analysis on diagnoses, procedures, DRG/APC and charge codes.
• Ensure billed coding aligns with reimbursement requirements and quality standards.
• Review outpatient coding for proper billing of injections and infusions.
• Train new hires, provide guidance, and support continuous process improvement.

Skills

Leadership

Data analytics

EHR systems

Oracle Cerner

Education

Associate's degree in nursing

California RN license

Job description

Blue Shield of CA is seeking a Clinical Coding Analyst RN, Consultant to lead a small coding team and review facility claims for ICD-10-CM/PCS coding accuracy. You will support quality audits, financial and care‑delivery improvement while staying compliant with payer rules.

The role requires an RN license in California, 7 years of relevant experience, and advanced coding certifications. A hybrid work arrangement and leadership development are offered.