Job Description

Your Work

As a Clinical Coding Analyst-Senior, you will be responsible for implementing a new code governance framework and maintaining industry-standard code updates across multiple systems. Conducts research and prepares files in compliance with member benefit language, contracts, and regulatory mandates. Develops and maintains policies and procedures while responding to regulatory inquiries and providing recommendations for accurate payment applications.

Responsibilities

Your Role

In this role you will:

• Manage the Code Load process, ensuring expert guidance in industry-standard code release integration with multiple systems
• Research and prepare files using industry standard codes that meet the intent of regulatory mandates set forth by the state or federal agencies
• Research, develop and maintain payment policies based on industry or expert supported research
• Provide problem management recommendations on correct application of payment based on industry and internal research
• Reviewing medical records and claims for coding accuracy.
• Ensuring compliance with ICD-10, CPT, and HCPCS coding guidelines.
• Conducting audits to verify proper billing and reimbursement.
• Collaborating with cross functional departments to resolve coding discrepancies.
• Staying updated on regulatory changes affecting medical coding.

Qualifications

Your Knowledge and Experience

• Requires an AA degree at minimum
• AHIMA Certified CCS required
• AAPC Certified CPC a plus
• Requires 5-8 years of directly related professional experience and possesses deep technical abilities
• Strong analytical and problem-solving skills
• Intermediate proficiency in Microsoft Excel, Word, and PowerPoint.
• Requires advanced knowledge of job area typically obtained through advanced education combined with experience

About the Team

About Blue Shield of California and the Ascendiun Family of Companies

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Ascendiun, we believe in a brighter future for healthcare. As the parent to a family of four innovative healthcare companies, we're reimagining what's possible. Ascendiun is guided by the goal of transforming a dysfunctional American health care system into one worthy of our family and friends and sustainably affordable for everyone.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, and showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model:

At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working:

• Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:

o Member-facing and approved out-of-state roles remain remote.

o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.

o For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

• On-Site: Work from a business unit-approved office an average of four (4) or more days a week.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.