Coding Specialist

Blue Cross and Blue Shield of North Carolina • Remote Flex - North Carolina, NC

2d • $45,761 - $73,217

About The Position

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).

Requirements

• High school diploma or GED
• 3+ years of experience in related field.
• Certified Professional Coder.

Nice To Haves

• 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

Responsibilities

• 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.

Benefits

• 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

What This Job Offers

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