Health Services Coding Analyst, CPC Required

🕒 Junho 16

🗿 South Dakota – Remoto

🗿 South Dakota – Remote

⏰ Tempo Integral

🟠 Sênior

🔴 Especialista

🧐 Analista

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Wellmark Blue Cross and Blue Shield

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 1939

⚕️ Seguro de Saúde

Healthcare Insurance

Wellmark Blue Cross and Blue Shield é um provedor de seguro saúde que opera principalmente em Iowa e Dakota do Sul. A empresa oferece uma variedade de planos de seguro saúde, incluindo planos para indivíduos e famílias, Medicare Advantage, Suplemento Medicare e planos para grupos empresariais. A Wellmark enfatiza a oferta de opções de cobertura que atendem a diversas necessidades e orçamentos, e oferece recursos para gerenciar contas, pagamentos e acesso à saúde através de seu portal online, myWellmark. Além disso, a Wellmark fornece recursos para provedores, empregadores e produtores para impulsionar a eficiência nos negócios e a qualidade nos serviços de saúde.

Descrição

• Provide clinical leadership and subject-matter expertise to support the analysis, configuration, and administration of complex medical policy content within claims processing systems, including Plan General Exclusion (PGE) rules and FACETS table maintenance. • Ensure the accurate implementation of medical policies, review criteria, and authorization requirements, while maintaining the integrity of system infrastructure and serving as a key liaison between business and technical teams. • Research and analyze system and business issues, develop high-level requirements, test, and implement solutions, and audit and document outcomes. • Serve as an expert resource for medical policy configuration and PGE coding, mentoring and training Coding Specialists, and providing policy-related training and support to operational partners such as customer and provider services. • Maintain coding integrity by monitoring utilization trends to identify and resolve system configuration issues. • Collaborate with Utilization Management nurses, medical directors, and claims teams to resolve coding-related denials, overrides, and policy interpretation questions.

🎯 Requisitos

• Associate degree or direct and applicable work experience preferred. • Certified Professional Coder (CPC) required. • Clinical background which may include either formal education or training in a clinical or health-related discipline (such as nursing, medical assisting, surgical technology, health information management, or a related field) and/or direct work experience in a clinical or healthcare setting. • 7+ years of related healthcare experience in provider payment, claims, medical coding, or similar. • Demonstrated expertise and knowledge of medical coding and terminology. • Demonstrated strong attention to detail with the ability to multitask. • Strong interpersonal skills including clear and concise written and verbal communication. • Inquisitive nature, enthusiastic about developing and enacting new processes. • Strong workflow management skills with a sense of ownership, drive, and initiative to continuously improve outcomes. • Ability to communicate concepts clearly and concisely to individuals and groups and motivate others to achieve success with an eye toward promoting a culture of collegiality and excellence. • Demonstrated ability to obtain relevant information by relating and comparing data from different sources. • Proficiency in Microsoft Office applications including experience with spreadsheets, process mapping, presentation, and word processing. • Ability to adhere to quality and production metrics. • Some experience with and continued interest in coaching and mentoring others. • Demonstrated ability to consistently meet department work schedule.

🏖️ Benefícios

• Health insurance • Remote work options