Lead Clinical Coding RN - ICD-10 & Audits (Hybrid)

Blue Shield of CA; Long Beach (CA); Hybrid; USD 90,000 - 130,000; Full time

Job summary

Blue Shield of CA is seeking a Clinical Coding Analyst RN, Consultant to support the Facility Compliance Review team. You will lead a small team of coders, conduct in-depth quality audits for ICD-10-CM/PCS, EDC reviews, and UM evaluations, ensuring compliant billing and coding practices. Leadership and AHIMA/AAPC credentials are highly desirable.

Hybrid virtual role with initial in-office hours in PST; strong analytical, coding and leadership skills are essential for success.

Qualifications

• Associate's degree in nursing is required.
• Current unrestricted California RN License and/or in assigned states; CA license within 90 days if other state.
• 7 years of prior relevant experience.
• 3 years' inpatient coding experience.
• 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 (managed care) preferred.
• Strong attention to detail.
• Arbitration experience preferred.
• Independent motivation and solid work ethic required.
• Familiarity with EHR systems, Oracle Cerner, and ED coding leveling preferred.
• Strong attention to detail.

Responsibilities

• Support the FCR team in reviewing post-service prepayment facility claims for contract compliance and medical necessity.
• Lead and train the clinical coding team, review claims and perform quality audits.
• Review outpatient coding for billing accuracy related to injections/infusions, DRG/APC and charge codes.
• Ensure billed coding meets reimbursement, research, epidemiology and quality care criteria.
• Act as a resource for the team and drive refresher trainings when needed.

Skills

Leadership

Analytical thinking

Attention to detail

Motivation

Computer navigation

Education

Associate's degree in nursing

Tools

EHR systems (Cerner)

Oracle Cerner

Job description

Blue Shield of CA is seeking a Clinical Coding Analyst RN, Consultant to support the Facility Compliance Review team. You will lead a small team of coders, conduct in-depth quality audits for ICD-10-CM/PCS, EDC reviews, and UM evaluations, ensuring compliant billing and coding practices. Leadership and AHIMA/AAPC credentials are highly desirable.

Hybrid virtual role with initial in-office hours in PST; strong analytical, coding and leadership skills are essential for success.