Prof/Ancillary Auditor ll

BlueCross BlueShield of Tennessee-posted 3 days ago
Full-time • Mid Level
Remote • Chattanooga, TN
5,001-10,000 employees
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Are you passionate about ensuring accuracy and compliance in clinical coding? The Professional and Ancillary Audit Department at BCBST is seeking a dedicated Coding Auditor to join our team and perform thorough claims payment quality and clinical coding compliance audits. Your role will be pivotal in identifying and addressing opportunities for improvement, ensuring our processes meet the highest standards. The ideal candidate will possess a Bachelor's degree or equivalent work experience, along with at least 4 years of professional or facility inpatient/outpatient coding and auditing experience. Current AHIMA or AAPC certification of CPC or equivalent for professional auditing is required. Facets experience would be a plus. Join us in making a difference in healthcare quality and compliance!

  • Presenting and communicating audit results to appropriate parties; recommending corrective course of action.
  • Conducting claims audits and serving as subject matter expert to management and internal or external stakeholders.
  • Planning and conducting investigations for certain claims; identifying potential subrogation or fraud and engaging special investigate unit as needed.
  • Providing technical and consulting support/training for quality and compliance audits.
  • Bachelor's Degree or equivalent work experience required.
  • Equivalent experience is defined as 4 years of professional work experience in a corporate environment.
  • 4 years- Professional/ancillary or facility inpatient/outpatient coding and/or auditing experience in an applicable setting.
  • Current AHIMA or AAPC coding certification of CPC or equivalent for Professional Ancillary Audit team and CCS or equivalent for Facility Audit team required.
  • 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 , as well as billing requirements (CMS-1500 and/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
  • Independent, Sound decision-making and problem-solving skills
  • Facets experience would be a plus.
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