Lead Clinical Coding Analyst RN | Remote/Hybrid

Blue Shield of CA; Huntsville (AL); Hybrid; USD 80,000 - 105,000; Full time

Job summary

Blue Shield of CA seeks a Clinical Coding Analyst RN, Consultant to support the Facility Compliance Review (FCR) team. You will review post-service prepayment facility claims for contract compliance, medical necessity, and hospital-acquired conditions, supervising two coders and mentoring new hires in ICD-10-CM/PCS coding and DRG reviews.

The role requires an Associate's degree in nursing, an unrestricted CA RN license or a license in the assigned state, 7 years of experience, 3 years inpatient

Qualifications

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

Skills

Attention to detail

Independent motivation

Strong work ethic

Computer navigation skills

Data analytics

EHR systems familiarity

Education

Associate's degree in nursing

Tools

Oracle Cerner

EHR systems

Job description

Blue Shield of CA seeks a Clinical Coding Analyst RN, Consultant to support the Facility Compliance Review (FCR) team. You will review post-service prepayment facility claims for contract compliance, medical necessity, and hospital-acquired conditions, supervising two coders and mentoring new hires in ICD-10-CM/PCS coding and DRG reviews.

The role requires an Associate's degree in nursing, an unrestricted CA RN license or a license in the assigned state, 7 years of experience, 3 years inpatient