BCBST BlueCross BlueShield of Tennessee, Inc. is seeking a Coding Auditor to join our organization. In this role, you will conduct comprehensive claims payment quality reviews and clinical coding compliance audits to identify improvement opportunities and ensure processes meet high industry standards. You will leverage Enterprise-AI approved tools in your daily work.
What You'll Do
- Communicate audit results to appropriate parties and recommend corrective courses of action.
- Review claims materials and medical record information to assess the accuracy of provider-submitted claims.
- Plan and conduct investigations for certain claims, identifying potential subrogation or fraud and engaging the special investigation unit as needed.
- Document audit results and support the development of audit policies and procedures.
What We're Looking For
- Bachelor's Degree or 4 years of equivalent professional work experience in a corporate environment.
- 2 years of professional/ancillary or facility inpatient/outpatient coding and/or auditing experience.
- Current AHIMA or AAPC coding certification (preferably CPC or CCS), or the ability to 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.
- Proficient in Microsoft Office (Outlook, Word, Excel, and PowerPoint).
- Proficient oral, written communication, 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, and results-driven.
- Solid knowledge of provider reimbursement methodologies, ICD-10 CM/PCS, CPT, HCPCS, and applicable billing requirements (CMS-1500 or UB-04).
- Ability to apply appropriate contract language, billing guidelines, and medical and reimbursement policies.
- Must deal with continual resistance from providers to the audit and recovery process.
Nice to Have
- Experience with Facets is a plus.
Technical Stack
- Facets
Team & Environment
You will be part of the Professional and Ancillary Audit Department.
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.
