Health Services Coding Analyst, CPC Required

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🗿 South Dakota – Remote

🗿 South Dakota – Remote

⏰ Full Time

🟠 Senior

🔴 Lead

🧐 Analyst

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Wellmark Blue Cross and Blue Shield

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1939

⚕️ Healthcare Insurance

Healthcare Insurance

Wellmark Blue Cross and Blue Shield is a health insurance provider operating primarily in Iowa and South Dakota. The company offers a range of health insurance plans including individual and family plans, Medicare Advantage, Medicare Supplement, and employer group plans. Wellmark emphasizes providing coverage options that meet diverse needs and budgets, and offers resources for managing accounts, payments, and health care access through their online portal, myWellmark. Additionally, Wellmark provides resources for providers, employers, and producers to drive business efficiency and quality in health care services.

📋 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. • Mentor and train Coding Specialists, and provide policy-related training and support to operational partners such as customer and provider services.

🎯 Requirements

• 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’ or related health care 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 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.

🏖️ Benefits

• Employees can work remotely