About this Coding Specialist role at Blue Cross and Blue Shield of North Carolina
Job Description
The Coding Specialist will use clinical and coding expertise to analyze medical records and charts in relation to provider coding. You will identify physician practices with complex coding patterns and report relevant data to the Centers for Medicare and Medicaid Services (CMS).What You'll Do
Analyzes necessary documentation, including medical records/charts, and applies clinical coding expertise to evaluate appropriateness of provider coding and reports relevant data to the Centers for Medicare and Medicaid Services (CMS).
Uses all resources to ensure compliance and understanding of the CMS Hierarchical Condition Category (HCC) payment methodology.
Develops and maintains professional working relationships with Medical Providers and their staff necessary to facilitate onsite review of medical records.
Maintains documents for tracking audit results, status of reviews etc.
What You Have
High school diploma or GED
3+ years of experience in related field.
Certified Professional Coder.
Bonus Points
Experience reviewing and assigning medical codes, preferably in a health insurance, claims, payment integrity, or reimbursement environment
Strong understanding of Emergency Department (ED/ER) coding and medical claim review processes
Ability to work independently while maintaining high levels of productivity and accuracy
Demonstrated success in a fast-paced, production-oriented environment and adaptability to continuous change.
Experience working under quality review standards with a focus on accuracy and compliance
What You’ll Get
The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
Work-life balance, flexibility, and the autonomy to do great work
Medical, dental, and vision coverage along with numerous health and wellness programs
Parental leave and support plus adoption and surrogacy assistance
Career development programs and tuition reimbursement for continued education
401k match including an annual company contribution
Salary Range
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
*Based on annual corporate goal achievement and individual performance.
Skills
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