Job Description

Your Role

As a Clinical Coding Analyst, Experienced specializing in code governance, you will play a pivotal role in ensuring coding standards, compliance, and best practices across development teams. Your responsibilities will include implementing and maintaining a code governance framework, conducting code reviews, optimizing development workflows, and ensuring adherence to industry standards. You will collaborate with cross-functional teams to establish coding guidelines, automate governance processes, and enhance overall software quality and security. Your expertise will drive efficiency, consistency, and compliance in coding practices, supporting scalable and maintainable solutions.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work

In this role, you will:

• Provide expert input to quarterly and annual industry standard code maintenance for multiple systems
• Research and prepare benefit files using industry standard codes that meet the intent of member benefit language and/or contracts, and regulatory mandates set forth by the state or federal agencies
• Develop payment policies based on industry or content expert-supported research
• Provide problem management recommendations on correct application of payment and benefits based on industry and internal research
• Conduct research and provide recommendations on industry standard editing for appropriate application in the current system in accordance with Blue Shield of CA payment policies and regulatory guidelines
• Collaborate with cross-functional departments to implement code governance framework

Your Knowledge and Experience

• HS Diploma or equivalent required; AA degree preferred
• AHIMA Certified CCS or CCS-P and/or AAPC CIC, CPC or COC required
• Preferred certification as CCS-P
• Possess deep technical abilities
• Work history in one of more of the following: 2 to 3 years of Provider billing experience in a lead, supervisory or management role; or 1 to 2 years in a payor environment working directly with payment quality and accuracy in a claims processing, providing contracting or audit capacity or; 1 to 2 years in a compliance or audit function within a health care system
• Requires broad theoretical job knowledge typically obtained through advanced education
• Intermittent proficiency in Microsoft Excel, Word and PowerPoint

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.