Capital BlueCross is the leading health solutions and insurance company in Central Pennsylvania and the Lehigh Valley. As a partner in the community’s health for nearly 80 years, we offer health insurance products, services, and innovative technology solutions that provide peace of mind to consumers and promote health and wellness for our customers.
Headquartered in Harrisburg, Pa., this capital city offers something for everyone, including access to the outdoors, with mountains, rivers and streams close by, and shore points within a half day’s drive. Major east coast cities such as Philadelphia, New York, Baltimore, and Washington, D.C. are just a few hours away by car. The area is also bolstered by multiple colleges and universities offering top notch higher education. A lively arts scene is enjoyed in the Harrisburg area as well as a variety of family entertainment venues, including amusement parks and sports arenas that make the area an ideal location for families.
More than a health insurer, the company delivers innovative solutions through a
family of diversified businesses that is creating a healthier future and lowering health care costs. Among these solutions are patient-focused care models, leading-edge data analytics, and digital health technologies.
We offer a highly competitive, market-driven compensation/benefits plan. Capital BlueCross is also committed to providing physical activity and wellness opportunities for our employees. We offer a convenient on-site fitness center, wellness incentives, and access to personal fitness training sessions to help employees meet their health goals. We have been recognized as a 2016 Platinum-Level Fit-Friendly Worksite by the American Heart Association and were named #3 on Training Magazine’s list of the top 125 globally ranked training programs.
Our innovative Capital Blue Health and Wellness Centers located in Enola and Center Valley provide in-person service and inspiration to help people reach their health goals. Each one is open to the public and includes a fitness studio, Healthy You Café and on-site care guides skilled in multiple areas, including nutrition and biometrics screening. Capital BlueCross employees can take advantage of the many services offered at Capital Blue at little to no cost.
Capital BlueCross is an independent licensee of the BlueCross BlueShield Association. We are an equal opportunity/affirmative action employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law. We offer a highly competitive, market-driven compensation/benefits plan. Engage with us on LinkedIn, Twitter, Facebook or Instagram.
Our Clinical Coding Consultants/Registered Nurses are responsible for researching and identifying CPT, CDT, HCPCS, ICD-10 and revenues (codes) that are applicable to the business needs of internal and external customers. Will serve as liaison to business units with coding/configuration priority issues, and research questions and issues from internal customers as they relate to reimbursements, medical policy and utilization. Must be cognizant of how coding impacts commercial and Medicare lines of business, as well as professional and facility contractual arrangements. Ideal candidates will be highly analytical/clinical with a current RN license and minimum 3 to 6+ years of coding background, preferably in managed care/health insurance. Must have AAPC (CPC) or similar certification; strong working knowledge of ICD-10, CPT, CDT, HCPCS and revenue codes; knowledge of the principles of professional and facility payment structures, benefit structures and claims adjudication processes; knowledge of Government regulatory requirements (PPACA, CMS, DOH, Medical Assistance) and Accrediting Agency requirements (NCQA, URAC, CHIP and Medical Assistance); proficiency with Word/Excel/Access; and excellent verbal and written communication skills.
The Medical Coding Specialist will be responsible for researching and identifying CPT, HCPCS, ICD-10 and revenue codes as they apply to Capital BlueCross’ expense/claims data/risk management objectives. Candidates must be highly analytical with proficiency in Microsoft Outlook, Word, Excel and SharePoint, ICD10, CPT, HCPCS, Revenue Codes and DRGs. Must have basic knowledge of Government and Accrediting Agency regulatory requirements (PPACA, CMS,DOH, Medical Assistance, NCQA, URAC) and knowledge of emerging treatment modalities and payment structures of claims/insurance benefits. Experience in Facets claims is beneficial. We’re looking for a professional with 3+ years’ experience, preferably in the managed care or health insurance industry. Bachelor’s degree and CPC certification are needed. COC and CIC is a plus.
Interested and qualified candidates should apply online at