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BlueCross and BlueShield of TennesseePositions can be located in Memphis, Jackson or Knoxville.Auditor performs retrospective audits on paid claims, conducts meetings with hospital administrators and department directors, CFO's, and physicians to address audit findings and billing issues. The audits may consist of routine periodic reviews, member requests, employee group requests and requests from other departments within the company. This position may assign and validate documentation for correct coding including but not limited to the following: CPT codes for ER, outpatient surgery, ICD-9-CM codes for primary and secondary diagnoses and procedures, and DRG assignments. The audit findings and other pertinent information must be reported clearly and concisely with recommendations to upper management and the claims recovery areas at BCBST and to hospital administration.  Incumbent determines focus and scope of each routine and follow-up or focused audit. Audits include all types of institutional providers and may be performed in-house and on site.  Audits may encompass all BCBST products.  Positions can be located in Memphis, Jackson or Knoxville.Qualifications:• Required qualifications include: CCS (Certified Coding Specialist) certification, RN (Registered Nurse) with current licensure in the state of Tennessee, RHIT (Registered Health Information Technician) or RHIA licensure (Registered Health Information Administrator) • Will consider candidate with RN, RHIT or RHIA licensure who does not currently hold CCS certification on condition of successful obtaining certification within 18 months of hire. • 5 years relevant professional experience with at least 2 years of hospital inpatient coding or at least 5 years of Facility Auditing, or at least 5 years of relevant audit experience in an acute care facility, other institutional healthcare provider, or in the insurance industry. • Must maintain coding and nursing or health information credentials through CEU's, licensing fees and other criteria pertinent to credentials held. • Solid knowledge and understanding of provider reimbursement methodologies, ICD-9-CM, CPT, HCPCS and UB-92 coding, UHDDS coding guidelines, AHA Coding Clinic. • Must be proficient in use of a PC and related software (e.g. Word, Excel, and Access.) • Ability to investigate, analyze and apply contract language, billing guidelines, medical and reimbursement policies. • Must have strong written, and oral communication skills and be capable of handling confrontational encounters in a positive manner. • Must have proven problem-solving abilities, strong analytical skills, initiative, and the ability to work independently. • Must be well organized and have experience managing multiple assignments meeting deadlines. • Must be able to travel 70 to 80% of the time.Please apply via our career site at:https://www.bcbst.com/about/careers/openings/