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Job Description

The incumbent will use clinical and coding expertise to analyze medical records and charts in relation to provider coding. The Coding Analyst identifies physician practices with complex coding patterns and reports relevant data to the Centers for Medicare and Medicaid Services (CMS).

What You'll Do

+ 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.

What You'll Bring

+ High school diploma or GED

+ 3+ years of experience in related field

+ Certified Professional Coder

Bonus Points

+ Medicare experience

What You'll Get

+ The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community

+ Work-life balance, flexibility, and the autonomy to do great work

+ 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

+ Learn more (https://careers.bluecrossnc.com/global/en/benefits)

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

_*Based on annual corporate goal achievement and individual performance._

$47,300.00 - $66,600.00

Skills

C++ Programming Language, Clinical Documentation, Clinical Documentation Review, Hyper Text Markup Language (HTML), ICD Coding, Medicaid, Medical Billing and Coding, Medical Documentation, Medical Insurance Coding, Medical Record Analysis, Medical Records Management, Medicare, Medicare Plans, MySQL, Payment Analysis, Python (Programming Language), Structured Query Language (SQL)

About Us

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.

Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.

Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview (https://www.e-verify.gov/employees/e-verify-overview) for English or Visión General de E-Verify (https://www.e-verify.gov/es/empleados/vision-general-de-e-verify) for Español.

Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at [email protected] .

For most roles, you can choose where to work - fully remote in one of the states listed below, in the office, or a hybrid of the two:

Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming