Why should you join the BlueCross BlueShield of South Carolina family of companies Other companies come and go but weve been part of the national landscape for more than seven decades with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina and much more. We are one of the nations leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy consider joining our team!

Position Purpose: Reviews medical documentation to perform a variety of coding validations for multiple lines of business under Medicare/TRICARE to determine accuracy of billing and payment. Reassigns and sequences diagnostic and procedural codes using universally recognized coding system as appropriate. Compiles and analyzes statistics to determine focus areas for targeted medical review activities where there is the greatest potential for inappropriate Medicare/TRICARE payments.

Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment with the ability to work from home when needed. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary given the business need to work occasional overtime. You may be required to travel between buildings. This role is located at 4101 Percival Road Columbia SC 29229.

What Youll Do:

• Determines methodology to identify cases for DRG HIPPS HCPCS RUG and APC validation. Conducts targeted coding documentation reviews and validation reviews coordinating rate adjustments and adjudication of corresponding claims. Utilizes Grouper Rover MDS QC tool or other appropriate software for code validation.
• Compiles/analyzes statistics to determine focus areas for targeted medical review activities where there is the greatest potential for inappropriate Medicare/TRICARE payments demonstrating records reviewed outcomes trends and savings. Notes deficiencies and makes recommendations to management and others as appropriate/requested. May complete appropriate paperwork/documentation regarding claim/encounter information to correct deficiencies.
• Provides coding guidance to clinical review staff. Develops necessary training or reference materials for review staff.
• Consults with appeals provider outreach and education and other supported areas of division as needed as a resource for medical records and coding issues.

To Qualify For This Position Youll Need The Following:

Required Education: Associates in a job related field
Degree Equivalency: Graduate of Accredited School of Nursing or successful completion of examination offered by American Health Information Management Association (AHIMA) or Academy of Professional Coders (AAPC)
Required Work Experience: 1 year either ICD-9 DRG APC HIPPS HCPCS or RUG coding and validation; or 2 years: 1 year clinical experience and 1 year in either DRG APC HIPPS HCPCS or RUG coding and validation.
Required Education: Associates in a job related field. Degree Equivalency: Graduate of Accredited School of Nursing or successful completion of examination offered by American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC).
Required Skills and Abilities: Working knowledge of word processing software. Knowledge/understanding of medical terminology and medical coding. Good judgment skills. Demonstrated customer service and organizational skills. Demonstrated proficiency in spelling punctuation and grammar skills. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion.
Required Software and Other Tools: Microsoft Office.
Required Licenses and Certificates: Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) OR Active RN licensure in state hired OR active compact multistate RN license as defined by the Nurse Licensure Compact (NLC).

We Prefer That You Have The Following:

Preferred Education: Associate Degree- Nursing or Four year degree in Health Information Management.
Preferred Work Experience: 2 years-medical coding experience.
Preferred Skills and Abilities: Knowledge/understanding of Medicare billing process. Working knowledge of spreadsheet and database software.
Preferred Software and Other Tools: Working knowledge of Microsoft Excel Access or other spreadsheet/database software.

Our Comprehensive Benefits Package Includes The Following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• Subsidized health plans dental and vision coverage.
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies theaters zoos theme parks and more

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next:

After submitting your application our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age race color national origin sex religion veteran status disability weight sexual orientation gender identity genetic information or any other legally protected status. Additionally as a federal contractor the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities pregnant individuals individuals with pregnancy-related conditions and individuals needing accommodations for sincerely held religious beliefs provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment please email or call ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Heres moreinformation.

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