Are you driven by precision and committed to maintaining excellence in clinical coding? The Professional and Ancillary Audit Department at BCBST is seeking a skilled Coding Auditor to join our team in conducting comprehensive claims payment quality reviews and clinical coding compliance audits. In this role, you’ll play a key part in identifying improvement opportunities and ensuring our processes consistently meet the highest industry standards.

The ideal candidate will have a Bachelor’s degree or equivalent experience, along with a minimum of two years of professional or facility inpatient/outpatient coding and auditing experience. An active AHIMA or CPC certification is required, or the ability to obtain CPC within one year of hire. Experience with Facets is a plus. We are looking for a candidate who is excited and interested in leveraging Enterprise-AI approved tools in their daily work.

Join us in helping elevate healthcare quality and compliance!

Job Responsibilities

• Communicating audit results to appropriate parties; recommending corrective course of action.
• Reviewing the claims materials and medical record information submitted and assessing accuracy of provider submitted claims.
• Planning and conducting investigations for certain claims; identifying potential subrogation or fraud and engaging special investigate unit as needed.
• Documenting audit results and supporting the development of audit policies and procedures.

Job Qualifications

Education

• Bachelor's Degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment.

Experience

• 2 years - Professional/ancillary or facility inpatient/outpatient coding and/or auditing experience in an applicable setting.

​Skills\Certifications

• Current AHIMA or AAPC coding certification preferably CPC or CCS, will consider candidate who does not currently hold certification with the condition that the incumbent will successfully complete the certification exam within 12 months of employment.
• 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 and applicable billing requirements (CMS-1500 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

N/A

Number of Openings Available

0

Worker Type:

Employee

Company:

BCBST BlueCross BlueShield of Tennessee, Inc.

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.