All about us

You likely know us as an insurance company, but that’s just a portion of what we do. Hundreds of thousands of North Dakotans trust us to provide them with personalized service and unmatched access to care. It’s a mission we take seriously.

We also work with entities throughout the state to challenge the cost and complexity of health care in North Dakota. This uncompromising goal requires caring, innovative people who are ready and willing to help create a new level of health and well-being in North Dakota and beyond.

Work environment

This opportunity is eligible for an in-office, hybrid or remote work arrangement. We empower our employees to find a work style that is best for them. Learn more at Life at Blue | BCBSND .

This position is eligible for internal and external applications.

Certification requirements

• A Certified Professional Coder (CPC), Registered Heath Information Technician (RHIT), Registered Heath Information Administrator (RHIA), or similar certification is required.

Pay Information

• Pay Level: 021
• FLSA Category: Non-Exempt – Hourly
• Individual pay will be based on skills, experience, qualifications, location, internal equity, and other relevant factors.
• Opportunities for continued salary growth through a performance-based merit program.

A day in the life

The Fraud and Abuse Coding Analyst reviews claims and corresponding medical records to verify appropriate coding, billing, and compliance with company policy. This position determines the most effective method of auditing and documents clear justification to support findings.

Your responsibilities will include

• Reviews moderately complex professional, institutional claims and corresponding medical records and documentation to verify coding and billing are appropriate based on current guidelines and policies. Determines the most effective and efficient methods of auditing based on each case. Analyzes the data collected from internal and external resources that support the audit. Documents all steps of the audit and preserves evidence per established procedures.
• Documents clear justification to support all irregular findings. References the appropriate resources used to support findings. Records the financial impact of incorrect coding into the case management system. Communicates findings effectively with providers in both written and verbal form.
• Identifies potential fraud, waste or abuse using software, tips, data analysis, and other available means. Analyzes the appropriateness of proceeding with an investigation or audit. Starts the audit process based on findings.
• Works across departments to facilitate the reprocessing of claims, enhance system edits based on case findings, and provide education on fraud, waste, and abuse. Helps conduct training for both internal and external clients on new coding initiatives.
• Serves on committees and special projects, as assigned.
• Performs work under general supervision. Handles moderately complex issues and problems and refers more complex issues to higher-level staff.

What you need to succeed

• A Bachelor's degree in Healthcare Administration, Business, or a related field.
• 3 years of experience in clinical coding or related experience.
• Experience with in-patient coding is highly preferred.
• A Certified Professional Coder (CPC), Registered Heath Information Technician (RHIT), Registered Heath Information Administrator (RHIA), or similar certification is required.
• Skilled in interpreting and analyzing data with an analytical mindset.
• Desire to collaborate and communicate with team members and other departments across the organization.
• Be a problem solver with the ability to make decisions.

Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

Benefits and perks

• Wellness incentives including well-being lifestyle spending accounts, employee assistance program and employee discounts.
• Encouraged paid time off including paid holidays and flexible holidays to use as you wish.
• 16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
• Employee recognition, community initiative events and yearly company outings.
• Workplace flexibility offering different options for working arrangements and the freedom to make time for important commitments.
• Our core benefits include health, dental, vision and life insurance, short-term and long-term disability and paid parental leave.

Equal opportunity employment

Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email careers@bcbsnd.com.

This job posting will be closed 11/13/2024 at 8:00 a.m. (CT). No further applications will be considered.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)