Hybrid Lead Clinical Coding RN – ICD-10/DRG Audits

Blue Shield of CA; Oakland (CA); Hybride; USD 110 000 - 150 000; Plein temps

Résumé du poste

Blue Shield of California is seeking a Clinical Coding Analyst RN, Consultant to support the Facility Compliance Review team and a small coder group. You will review claims for medical necessity and coding accuracy, lead trainings, and supervise the coding process to ensure compliant reimbursement.

The role requires a CA RN license, 7 years of relevant experience, 3 years inpatient coding, and professional certifications (CCS/CPC-RHIT/RHIA/CDIP). Hybrid work with initial PST hours in CA.

Qualifications

• Associate's degree in nursing (required).
• Current unrestricted California RN license; other state license acceptable with CA within 90 days.
• 7 years of prior relevant experience.
• 3 years inpatient coding experience.
• One of CCS, CPC-CIC, RHIT, RHIA, CCDS or CDIP is required.
• Utilization management experience is required.
• Ability to analyze claim data analytics is required.
• Health plan experience (managed care) preferred.
• Strong attention to detail.
• Arbitration experience preferred.
• Independent motivation and strong computer navigation skills.
• Familiarity with EHR systems; Oracle Cerner and ED EM leveling experience preferred.

Responsabilités

• Lead and train the FCR team; mentor staff and coordinate refresher trainings.
• Review post-service prepayment facility claims for contract compliance and medical necessity.
• Audit outpatient coding for injection and infusion billing accuracy.
• Review medical records; perform coding analysis on diagnoses, procedures, DRG/APC and charge codes.
• Ensure billed coding aligns with reimbursement requirements and quality of care objectives.

Connaissances

Attention to detail

Independent motivation

Computer navigation

Leadership experience

Data analysis

Formation

CCS

CPC-CIC

RHIT

RHIA

CCDS

CDIP

CA RN license

Associate's degree in nursing

Outils

Oracle Cerner

Description du poste

Blue Shield of California is seeking a Clinical Coding Analyst RN, Consultant to support the Facility Compliance Review team and a small coder group. You will review claims for medical necessity and coding accuracy, lead trainings, and supervise the coding process to ensure compliant reimbursement.

The role requires a CA RN license, 7 years of relevant experience, 3 years inpatient coding, and professional certifications (CCS/CPC-RHIT/RHIA/CDIP). Hybrid work with initial PST hours in CA.