Health Services Coding Analyst, CPC Required

🕒 il y a 4 jours

🗿 South Dakota – Distant

🗿 South Dakota – Remote

⏰ Temps Plein

🟠 Senior

🔴 Expert

🧐 Analyste

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Wellmark Blue Cross and Blue Shield

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1001 - 5000 employés

Fondée en 1939

⚕️ Assurance santé

Healthcare Insurance

Wellmark Blue Cross and Blue Shield est un fournisseur d'assurance santé opérant principalement en Iowa et dans le Dakota du Sud. L'entreprise propose une gamme de plans d'assurance santé, y compris des plans individuels et familiaux, Medicare Advantage, Medicare Supplement, ainsi que des plans de groupe pour employeurs. Wellmark met l'accent sur la fourniture d'options de couverture répondant à des besoins et des budgets variés, et offre des ressources pour la gestion des comptes, des paiements et de l'accès aux soins de santé à travers leur portail en ligne, myWellmark. De plus, Wellmark fournit des ressources pour les prestataires, employeurs et producteurs afin d'améliorer l'efficacité des activités et la qualité des services de soins de santé.

Description

• 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.

🎯 Exigences

• 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.

🏖️ Avantages

• Health insurance • Remote work options