Medi-Cal Coder, Senior

At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for - LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in - Join us!


Job Description
  • Serve as an expert Medi-Cal resource in the areas of coding, documentation, auditing, including CMS/HHS regulations and compliance issues surrounding requirements for risk adjustment.
  • Maintain currency in all coding and reimbursement methods researching literature and attends professional seminars, workshops, and conferences as required by the AHIMA and/or AAPC to maintain professional certification.
  • Review and monitors all Medi-Cal, HIPAA and CMS regulations for updates and changes pertaining to Medi-Cal programs. Determine and implement changes needed for systems and processes.
  • Cross-functional collaboration with multiple teams and functions.
  • May train physicians and other staff regarding documentation, billing and coding and provides feedback to physicians regarding documentation practices upon request.
  • Works to achieve operational targets with direct impact on departmental results.
  • Works independently under limited supervision.
  • May be responsible for entire projects or processes within job area.
  • Responsible for improving processes, systems or products to enhance performance of the job area.
  • Communicates with parties within and outside of own department, with the ability to educate others on complex disciplines.
  • May have responsibility for communicating with parties' external to the organization (e.g., customers, vendors, etc.).
  • Works to influence parties within and outside of the job function at an operational level regarding policies, practices and procedures.
  • May be responsible for providing guidance, coaching and training to other employees within job area.
  • May manage projects requiring the responsibility of delegating work and reviewing resulting work product.
  • Other duties as assigned.


Education, Knowledge and Experience
  • Associate's degree required. Bachelor's degree preferred (preferably in Healthcare or relevant field) or equivalent work experience
  • Acceptable coding certification; CCS/CCS-P required
  • A minimum of 3-5 years of relevant Medi-Cal coding experience with a high-level of coding expertise
  • Knowledge of Coding software & Microsoft Office; Word, Excel, Power Point, and Access
  • Excellent analytical and problem-solving skills
  • 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.

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.
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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.EEO Policy