Blue Cross Blue Shield of Arizona · 1 month ago
Payment Integrity Coding Coordinator - Remote AZ
United States
Full-time
Remote
Entry, Mid, Senior Level
2+ years expBlue Cross Blue Shield of Arizona is a health insurance provider dedicated to inspiring health and making it easy for individuals and businesses. The Payment Integrity Coding Coordinator is responsible for auditing claims to ensure proper coding and billing practices, identifying discrepancies, and providing education to providers to promote compliance.
Financial ServicesHealth CareHealth InsuranceInsurance
Responsibilities
Through data analysis, identify areas of high risk for coding and billing variances
Collaborate with analyst to define reporting criteria to evaluate shifts in utilization and provider coding patterns
Interprets data, draws conclusions, and reviews findings with all levels within the organization
Conducts audits of claims by selecting claims that have been identified as in scope for audit. Audits claims, medical records and corresponding documentation for appropriate coding. Applies knowledge of medical coding, diagnostic-related group (DRG) and current coding guidelines
Performs hospital charge audits and itemized bill audits on all high dollar claims and as needed on other questionable charges applicable to outpatient/professional services
Makes complex coding determinations and uses concise reasoning citing the principles and rational used in making the determination
Prepares results/recommendations of the coding audit findings to the providers via claims adjustment notification letters and / or other direct communication. Articulates clear and concise recommendations that may be challenged by health care providers
Facilitates recovery efforts of claims that were identified as incorrectly billed
Participate on task teams and corporate committees as required, applying coding and analytical skills
Quantifies the financial impact for the company and reports findings to management
Acts as resource person for internal and external customers regarding coding and billing practices
Develop, maintain and follow detailed procedures on the process and business rules around audits
Manages ongoing audits and meets timeliness expectations
Develops and maintains collaborative internal relationships
Attend pertinent coding seminars and training, and use other resources as applicable, to maintain current knowledge of rapidly changing coding guidelines
Proactively review and identify potential areas of high risk for coding and billing variances
Develop and maintain a thorough understanding of medical coverage and reimbursement guidelines and make independent decisions
Facilitates meetings to discuss areas of difficulty and variance by researching recognized national coding guidelines and medical data to encourage uniformity and consistency of coding practices among providers
Participate on task teams and corporate committees as required, applying coding and analytical skills
Develop clear and concise recommendations for any potential coding or reimbursement changes including full rationalization and how it might interact with current processes and policies. Present recommendations to the appropriate audience for review and approval
Work closely with other areas of the company to ensure implementation and updates to methodologies are made timely and accurately
Share knowledge of skills, projects, and business needs with peers and less experienced analysts. Train new employees as needed
Plan and lead multiple projects and cross-functional teams from inception to completion. This includes working independently on creating timelines, working with other areas to define deliverables, monitoring progress, implementing the project and resolving/monitoring pre/post-implementation issues
Lead and/or participate on task teams and corporate committees as required, applying analytical skills and actively participating in a team environment to complete projects and accomplish goals
Demonstrate a strong business perspective, industry-knowledge, organizational skills and communication skills. Work with and present to all levels of management, including Executives
Independently manage and improve organizational processes. Evaluate and create new ways to do things while making sure to incorporate input from all key stakeholders. Keeps abreast of trends or technology that could improve work flow
Demonstrate complete ownership and accountability in all leadership roles, process improvements and recommendations
Identify and explore opportunities for medical and reimbursement policy changes that support claim savings goals, while maintaining focus on appropriate reimbursement levels and relativities
Perform independent research to identify coding and system issues that impact medical coverage guidelines and pricing, presenting recommendations for appropriate corrective measures to management following thorough analysis & independent decision, while actively participating in the resolution
Act as a liaison with health services, other divisions, external vendors and analysts to assure adequate communication and coordination of audit activities, medical and reimbursement policy and coding changes
Support and train other employees in lower levels. Help direct a thorough and efficient review of all audit work being produced in the area
Reports to a supervisor or manager who provides minimal supervision/project management. Develop own work-plans, and discusses timelines, prioritization, and objectives with supervisor or manager
Each progressive level includes the ability to perform the essential functions of any lower levels and mentor employees in those levels
The position has an onsite expectation of 0 days per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements
Perform all other duties as assigned
Qualification
Required
2 years of experience of professional/physician, inpatient, diagnostic and procedural coding, claims administration, claims auditing or related experience required (All Levels)
High-School Diploma or GED in general field of study (All Levels)
Certified Professional Coder (, CPC), or Certified Inpatient Coder (CIC)
Preferred
4 years of experience of medical coding, claims administration, claims auditing or related experience required (All Levels)
2 years of relevant hospital inpatient coding experience including DRG assignment
Experience with coding of all claim types (All Levels)
Associate or bachelor's Degree in any general field of study. (All Levels)
Certified Professional Coder ( CPC), Certified Inpatient Coder (CIC) (All Levels)
Company
Blue Cross Blue Shield of Arizona
Blue Cross Blue Shield of Arizona is a non-profit company that offers health insurance and financial services.
1001-5000 employees
H1B Sponsorship
Blue Cross Blue Shield of Arizona has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2024 (2)
2023 (5)
2022 (2)
2021 (1)
2020 (5)
Funding
Current Stage
Late StageLeadership Team
Pam Kehaly
President and Chief Executive Officer
Recent News
Morningstar.com
2025-11-22
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2025-10-30
2025-10-23
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