Senior RN Clinical Coding Lead - ICD-10/DRG Audits (Hybrid)

Blue Shield of CA; Columbus (OH); Hybrid; USD 85,000 - 120,000; Full time

Benefits offered by this job

Hybrid Virtual Work

Job summary

Blue Shield of CA is seeking a Clinical Coding Analyst RN, Consultant to support the Facility Compliance Review team in Columbus, OH. The role includes leading a small coder team, auditing ICD-10-CM/PCS, and ensuring medical necessity and correct DRG/APC billing.

The ideal candidate holds a nursing degree, California RN license (or state equivalent) and 3+ years inpatient coding with relevant certifications. Hybrid schedule with initial PST hours and leadership responsibilities.

Qualifications

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

Responsibilities

• Lead and train the FCR team; review claims and coding quality.
• Perform in-depth quality audits of hospital claims for ICD-10-CM/PCS, EDC, MS-DRG and APR-DRG.
• Assess medical necessity and billing appropriateness.
• Review outpatient coding related to injections and infusions.
• Provide leadership for trainings and act as resource for the team.

Skills

Leadership

Analytical skills

Attention to detail

Team collaboration

Education

Associate's degree in nursing

Current unrestricted California RN License (and/or state)

CPC/CCS/RHIT/RHIA/CDIS/CDIP certification

Tools

EHR systems (Cerner/Oracle)

Job description

Blue Shield of CA is seeking a Clinical Coding Analyst RN, Consultant to support the Facility Compliance Review team in Columbus, OH. The role includes leading a small coder team, auditing ICD-10-CM/PCS, and ensuring medical necessity and correct DRG/APC billing.

The ideal candidate holds a nursing degree, California RN license (or state equivalent) and 3+ years inpatient coding with relevant certifications. Hybrid schedule with initial PST hours and leadership responsibilities.