Coding Specialist
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Job Description
Coding Specialist reviewing medical records and provider coding for Blue Cross NC. Reporting complex coding patterns to CMS and supporting HCC compliance.
Responsibilities:
- Analyze medical records and charts in relation to provider coding
- Identify physician practices with complex coding patterns
- Report relevant data to the Centers for Medicare and Medicaid Services (CMS)
- Analyze documentation and apply clinical coding expertise to evaluate provider coding appropriateness
- Ensure compliance with and understanding of the CMS Hierarchical Condition Category (HCC) payment methodology
- Develop and maintain professional working relationships with medical providers and their staff to facilitate onsite medical-record reviews
- Maintain documents tracking audit results and review status
Requirements:
- High school diploma or GED
- 3+ years of experience in a related field
- Certified Professional Coder
- 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
Benefits:
- Work-life balance, flexibility, and autonomy
- Medical, dental, and vision coverage
- Health and wellness programs
- Parental leave and support
- Adoption and surrogacy assistance
- Career development programs
- Tuition reimbursement for continued education
- 401k match including an annual company contribution
- Annual Incentive Bonus
- Paid Time Off (PTO)
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