Clinical Coding Analyst, Experienced

Blue Shield of California • Woodland Hills, CA

6h

About The Position

As a Clinical Coding Analyst-Experienced, specializing in code governance, you will play a pivotal role in ensuring coding standards, compliance, and best practices across development teams. Your responsibilities will include implementing and maintaining a code governance framework, conducting code reviews, optimizing development workflows, and ensuring adherence to industry standards. You will collaborate with cross-functional teams to establish coding guidelines, automate governance processes, and enhance overall software quality and security. Your expertise will drive efficiency, consistency, and compliance in coding practices, supporting scalable and maintainable solutions.

Requirements

• HS Diploma or equivalent required; AA degree preferred
• AHIMA Certified CCS 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

Nice To Haves

• Preferred certification as CCS-P

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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED