Nurse Clinical Coding Lead — ICD-10, Claims & QA (Hybrid)

Blue Shield of CA; Denver (CO); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Blue Shield of CA is seeking a Clinical Coding Analyst RN, Consultant to lead a small coding team and support the Facility Compliance Review. You will review hospital and outpatient coding, perform ICD-10-CM/PCS, EDC, MS-DRG, and APR-DRG reviews, and ensure accurate billing according to reimbursement rules.

The role emphasizes leadership, QA audits, and training. Licensing requirements include a CA RN license and relevant coding credentials, with a hybrid work arrangement and potential office

Qualifications

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

Responsibilities

• Lead and mentor a small clinical coding team; assist with reviewing claims for ICD-10-CM/PCS, MS-DRG/APC, and DRG reviews.
• Review outpatient coding for appropriate billing related to injections and infusions.
• Train new hires and facilitate refresher trainings as needed.

Skills

Leadership experience

Attention to detail

Independent motivation

Data analytics

Strong computer skills

Education

CA RN license

CCS/CPC/RHIT/RHIA/CCDS/CDIP certifications

Tools

Oracle Cerner

EHR systems

Job description

Blue Shield of CA is seeking a Clinical Coding Analyst RN, Consultant to lead a small coding team and support the Facility Compliance Review. You will review hospital and outpatient coding, perform ICD-10-CM/PCS, EDC, MS-DRG, and APR-DRG reviews, and ensure accurate billing according to reimbursement rules.

The role emphasizes leadership, QA audits, and training. Licensing requirements include a CA RN license and relevant coding credentials, with a hybrid work arrangement and potential office