The Facility Audit Department at BCBST is searching for a talented Coding Auditor to join our dynamic team in performing detailed claims payment quality reviews and coding compliance audits. This role is essential in reviewing hospital claims to ensure appropriate reimbursement, as well as compliance with contracts, regulatory requirements, and BCBST guidelines. A unique aspect of this position is providing educational feedback and reports to TN facilities based on audit findings. While travel is not currently required, there may be rare occasions when traveling to a TN facility for an audit becomes necessary, so we’re seeking candidates who reside in Tennessee or contiguous counties.
The ideal candidate will bring a Bachelor’s degree or equivalent experience, together with at least two years of facility inpatient or outpatient coding and auditing experience, or reimbursement experience in a payer environment. An active AHIMA certification is required, or the willingness to obtain CCS within a year of hire. Experience with Facets, Care Advance, and other internal systems is highly valued. We are especially excited to find someone eager to use Enterprise-AI approved tools in their work, helping us uncover opportunities for improvement and drive greater efficiencies.
Job Responsibilities
- Communicating audit results to appropriate parties; recommending corrective course of action.
- Reviewing the claims materials and medical record information submitted and assessing accuracy of provider submitted claims.
- Planning and conducting investigations for certain claims; identifying potential subrogation or fraud and engaging special investigate unit as needed.
- Documenting audit results and supporting the development of audit policies and procedures.
Job Qualifications
Education
- Bachelor's Degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment.
Experience
- 2 years - Professional/ancillary or facility inpatient/outpatient coding and/or auditing experience in an applicable setting.
SkillsCertifications
- Current AHIMA or AAPC coding certification preferably CPC or CCS, will consider candidate who does not currently hold certification with the condition that the incumbent will successfully complete the certification exam within 12 months of employment.
- Ability to handle confidential and sensitive information.
- Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
- Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
- Proficient oral and written communication skills
- Proficient interpersonal and organizational skills
- Capacity to solve problems and manage multiple assignments with critical deadlines
- Proven decision making and problem solving skills
- Strong analytical skills
- Positive attitude, self-driven, engaging, proactive, results drive
- Solid knowledge and understanding of provider reimbursement methodologies, ICD-10 CM/PCS, CPT, HCPCS and applicable billing requirements (CMS-1500 or UB-04).
- Must have the ability to apply the appropriate contract language, billing guidelines, medical and reimbursement policies
- Must deal with continual resistance of providers to the audit and recovery process conducted by BCBST
Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR). *The definition for "routine basis" is defined as daily, weekly or at regularly schedule times.
Number of Openings Available
1
Worker Type:
Employee
Company:
BCBST BlueCross BlueShield of Tennessee, Inc.
Applying for this job indicates your acknowledgement and understanding of the following statements:
BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.
Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:
BCBST's EEO Policies/Notices
BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.