Lead Clinical Coding RN – ICD-10 & DRG Auditor

Blue Shield of CA; Hartford (CT); Hybrid; USD 110,000 - 170,000; Full time

Job summary

Blue Shield of California is seeking a Clinical Coding Analyst RN, Consultant to support the Facility Compliance Review team and lead a small coding staff. The role emphasizes accuracy in ICD-10-CM/PCS, DRG/APC audits, and medical necessity review, with responsibilities for training and quality assurance.

The position requires an RN license (CA preferred) or eligibility, CPC/CCS or similar certification, and experience in utilization management and data analytics.

Qualifications

• Associate's degree in nursing is required.
• Current unrestricted California RN license or eligibility in assigned states with CA license within 90 days of hire.
• 7 years of relevant experience with 3 years inpatient coding.
• Certifications: CCS, CPC-CIC, RHIT, RHIA, CCDS or CDIP preferred.
• UM experience and strong data analytics skills required.

Skills

7 years exp

Inpatient coding

UM experience

Data analytics

Managed care

Attention to detail

Leadership experience

EHR familiarity

ED coding

Independent motivation

Education

Associate's degree in nursing

CA RN license or eligibility

Tools

Oracle Cerner

Job description

Blue Shield of California is seeking a Clinical Coding Analyst RN, Consultant to support the Facility Compliance Review team and lead a small coding staff. The role emphasizes accuracy in ICD-10-CM/PCS, DRG/APC audits, and medical necessity review, with responsibilities for training and quality assurance.

The position requires an RN license (CA preferred) or eligibility, CPC/CCS or similar certification, and experience in utilization management and data analytics.