Lead Clinical Coding Analyst RN ICD-10 & Billing Compliance

Blue Shield of CA; Minneapolis (MN); Híbrido; USD 110 000 - 150 000; Tempo integral

Resumo da oferta

Blue Shield of CA is seeking a Clinical Coding Analyst RN, Consultant to support the Facility Compliance Review team in reviewing post-service claims for compliance and medical necessity. You will lead a small coding staff, train new hires, and review ICD-10-CM/PCS codes, DRG/APC reviews, and outpatient billing.

Hybrid virtual work with some in-office needs; requires CA RN license, CPC/CCS or similar certification, and several years of inpatient coding and UM experience.

Qualificações

• 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.
• Ability to analyze claim data analytics is required.
• Health plan experience 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 preferred.

Responsabilidades

• Review post-service prepayment facility claims for contract compliance and medical necessity.
• Lead a small clinical coder team and train new hires.
• Review ICD-10-CM/PCS codes, DRG/APC reviews, and outpatient coding for billing accuracy.
• Ensure billed coding aligns with reimbursement, research, and quality of care.
• Provide leadership and be a resource for the team.

Conhecimentos

Leadership experience

Analytical thinking

Attention to detail

Independent motivation

Formação académica

Associate's degree in nursing

Ferramentas

EHR systems (Cerner)

Oracle

Descrição da oferta de emprego

Blue Shield of CA is seeking a Clinical Coding Analyst RN, Consultant to support the Facility Compliance Review team in reviewing post-service claims for compliance and medical necessity. You will lead a small coding staff, train new hires, and review ICD-10-CM/PCS codes, DRG/APC reviews, and outpatient billing.

Hybrid virtual work with some in-office needs; requires CA RN license, CPC/CCS or similar certification, and several years of inpatient coding and UM experience.