Clinical Coding Analyst, Experienced – Certified Coder

Blue Shield of California is a nonprofit organization focused on transforming healthcare to be affordable and of high quality. The Clinical Coding Analyst will ensure coding standards and compliance, implement governance frameworks, and collaborate with teams to enhance coding practices.

Responsibilities

• Provide expert input to quarterly and annual industry standard code maintenance for multiple systems
• Research and prepare benefit files using industry standard codes that meet the intent of member benefit language and/or contracts, and regulatory mandates set forth by the state or federal agencies
• Develop payment policies based on industry or content expert-supported research
• Provide problem management recommendations on correct application of payment and benefits based on industry and internal research
• Conduct research and provide recommendations on industry standard editing for appropriate application in the current system in accordance with Blue Shield of CA payment policies and regulatory guidelines
• Collaborate with cross-functional departments to implement code governance framework

Skills

• HS Diploma or equivalent required; AA degree preferred
• AHIMA Certified CCS or CCS-P and/or AAPC CIC, CPC or COC required
• Possess deep technical abilities
• Work history in one of more of the following: 2 to 3 years of Provider billing experience in a lead, supervisory or management role; or 1 to 2 years in a payor environment working directly with payment quality and accuracy in a claims processing, providing contracting or audit capacity or; 1 to 2 years in a compliance or audit function within a health care system
• Requires broad theoretical job knowledge typically obtained through advanced education
• Intermittent proficiency in Microsoft Excel, Word and PowerPoint
• Preferred certification as CCS-P

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