RN Clinical Coding Lead – Hospital Claims & Audits

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

Benefits offered by this job

Hybrid work model

Job summary

Blue Shield of CA is seeking a Clinical Coding Analyst RN, Consultant to lead a small coding team and review post-service prepayment facility claims for contract compliance and medical necessity. You will analyze diagnoses, procedures, DRG/APC and charge codes while mentoring staff and coordinating with the Senior Manager.

Required are an associate degree in nursing, California RN license, and 7 years of relevant experience including 3 years inpatient coding; certifications CCS, CPC-CIC, RHIT,

Qualifications

• Requires Associate's degree in nursing and California RN license.
• 7 years of prior relevant experience
• 3 years inpatient coding experience
• Certifications in CCS, CPC-CIC, RHIT, RHIA, CCDS or CDIP are required
• Utilization management (UM) experience is required
• Ability to analyze claim data analytics is required
• Familiarity with EHR systems, Oracle (Cerner) and ED EM leveling experience preferred

Responsibilities

• Lead capacity overseeing a small clinical coding team and training new hires
• Review post-service prepayment facility claims for contract compliance and medical necessity
• Perform coding analyses on diagnoses, procedures, DRG/APC and charge codes
• Ensure billed coding aligns with reimbursement requirements and quality of care
• Mentor team and support Senior Manager in oversight

Skills

Leadership experience

Analytical skills

Independent motivation

Strong computer navigation skills

EHR familiarity

Oracle Cerner

Attention to detail

Education

Associate's degree in nursing

California RN license

CCS

CPC-CIC

RHIT

RHIA

CCDS

CDIP

Tools

Oracle Cerner

Job description

Blue Shield of CA is seeking a Clinical Coding Analyst RN, Consultant to lead a small coding team and review post-service prepayment facility claims for contract compliance and medical necessity. You will analyze diagnoses, procedures, DRG/APC and charge codes while mentoring staff and coordinating with the Senior Manager.

Required are an associate degree in nursing, California RN license, and 7 years of relevant experience including 3 years inpatient coding; certifications CCS, CPC-CIC, RHIT,