Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) — making us the only health insurance company in South Carolina with that rating. We’re the largest insurance company in South Carolina …and much more. We are one of the nation’s 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 that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Job Title: Medical Coding Specialist

Position Notes:

• Max Pay Rate: $27/hour.
• 3 years of ICD-10 or HCC experience is required.
• Work Hours/Schedule: 25 flexible hours per week. Available for meetings.
• Contract to Hire.
• Required License/Certification: CCS or CPC - RN not needed.
• Interview process: MS Teams Video.
• 90 days of training will be provided.
• Role is Remote - Occasionally will be required to come onsite for team meetings.
• BCBS will provide the equipment.

Top 2-4 PREFERRED/NICE TO HAVE skill sets/qualities:

• The manager is requiring 3 years of IDC-10 or HCC experience.
• Risk adjustment coding for all models.
• Coding a minimum of 25 charts per day.
• Hold an accuracy of 95%.
• Microsoft office skills.

Duties:

• 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.
• 60% 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.
• 25% 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.
• 10% Provides coding guidance to clinical review staff. Develops necessary training or reference materials for review staff.
• 5% Consults with appeals, provider outreach and education and other supported areas of division as needed as a resource for medical records and coding issues.

Required Skills and Abilities: 

• Required Education: Associate degree - Health Information Management, OR, Graduate of an 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 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). 
• Preferred Education: Associate degree- Nursing or Four-year degree in Health Information Management. 
• Preferred Work Experience: 2 years-medical coding experience. null
• 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. 
• 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. 
• Work Environment: Typical office environment. 

This is the pay range that Magnit reasonably expects to pay someone for this position is $22.74/hour - $27.00/hour. Benefits: Medical, Dental, Vision, 401K (provided minimum eligibility hours are met).

BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. 

Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty. If you're ready to join in a diverse company with secure, community roots and an innovative future, apply for a position now!