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

Blue Shield of CA

Chicago (IL)

Hybrid

USD 85,000 - 125,000

Full time

2 days ago

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Job summary

Blue Shield of California is seeking a Clinical Coding Analyst RN, Consultant to lead the Facility Compliance Review (FCR) team in post-service claim audits and coding accuracy. You will mentor two clinical coders, review records for ICD-10-CM/PCS, EDC and DRG/APC reviews, and ensure compliance with reimbursement standards.

You will train staff, analyze claim data, and support quality improvements while prioritizing accuracy and payer requirements.

Qualifications

7 years of prior relevant experience
3 years inpatient coding experience
UM experience required
Experience analyzing claim data analytics
Health plan (managed care) experience preferred
Familiarity with EHR systems and ED EM leveling preferred
Independent motivation and strong work ethic
Sharp attention to detail
Willingness to train and lead new hires

Responsibilities

Review post service prepayment facility claims for contract compliance and medical necessity
Lead and support a small clinical coding team in audits and quality reviews
Review medical records and perform coding analysis for diagnoses, procedures, DRG/APC
Ensure billed coding meets reimbursement, research and quality goals
Assist with training, refresher sessions and serving as a team resource
Collaborate on EMR/EHR related coding accuracy and system use