Remote Medical Coding Specialist - CMS & Compliance

Blue Cross and Blue Shield of North Carolina; North Carolina; Hybrid; USD 46,000 - 73,000; Full time

Benefits offered by this job

Work-life balance

Medical, dental, and vision coverage

Parental leave and adoption support

Tuition reimbursement

Job summary

Blue Cross NC is seeking a Coding Specialist to analyze medical records and provider coding using clinical expertise. You will report CMS-relevant data and ensure compliance with HCC payment methodologies. Build relationships with medical providers for on-site reviews and maintain audit-ready documentation.

The role emphasizes independent work in a fast-paced environment with focus on accuracy and compliance, within a Hybrid Flex setting across multiple states.

Qualifications

• Certified Professional Coder credential.
• Experience reviewing and assigning medical codes in health insurance or reimbursement environments.
• Strong understanding of ED/ER coding and medical claim review processes.
• Ability to work independently with high productivity and accuracy.

Responsibilities

• Analyze documentation and apply clinical coding expertise to evaluate provider coding accuracy.
• Report relevant data to CMS.
• Maintain documentation for audit results and review status.

Skills

Certified Professional Coder

Medical coding experience

Emergency Department coding

Independent work

Education

High school diploma or GED

Job description

Blue Cross NC is seeking a Coding Specialist to analyze medical records and provider coding using clinical expertise. You will report CMS-relevant data and ensure compliance with HCC payment methodologies. Build relationships with medical providers for on-site reviews and maintain audit-ready documentation.

The role emphasizes independent work in a fast-paced environment with focus on accuracy and compliance, within a Hybrid Flex setting across multiple states.