Medical Policy & Coding Support Coordinator, CPC/CPC-A Preferred

🔥 2 minutes ago

🗿 South Dakota – Remote

🗿 South Dakota – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Medical Billing and Coding

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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

• Support Medical Policy Team’s operations, including creating and managing monthly Medical Policy production timelines, quarterly production timeline for N/R/D Code processing, maintaining Medical Policy material distribution lists, and filing external appeals. • Verify that the monthly authorization table updates align with quality expectations and track performance metrics. • Support virtual monthly Medical Policy Committee (MPC) operations, including taking minutes, developing, circulating, and presenting agenda PowerPoint during monthly MPC virtual meetings. • Partner with the coding specialist role in the support of the Medical Policy Implementation Committee (MPIT). • Support Medical Policy leadership in initial research on impact of changes in vendor and BCBSA Reference Medical Policy changes and opportunities for new policy development. • Perform monthly medical policy coding analyses and SAP BusinessObjects reports to identify and recommend necessary changes based on comparison to BCBSA reference medical policies, sentinel commercial health plan benchmarks and utilization patterns and implementation of claim system edits to support its intent.

🎯 Requirements

• Associate's or bachelor's degree in a relevant field (e.g., health administration, business administration, or a related discipline) • Claims experience with knowledge of Facets is strongly preferred. • Familiarity with SAP BusinessObjects. • Certified Professional Coder (CPC) required. • Must attain the certification within 12 months of hire and maintain throughout employment. • 4+ years of experience in provider payment, claims or medical coding. • Demonstrates coding knowledge – e.g. ICD-10, HCPC, CPT. • Strong customer service and communication skills to respond to inquiries in a timely and professional manner. • Strong organizational and project management skills, with the ability to manage multiple tasks and deadlines effectively. • Strong written and verbal communication skills with the ability to express complex concepts clearly and concisely.

🏖️ Benefits

• Employees can work remotely • Medical Policy & Coding Support Coordinator (CPC/CPC-A preferred) • Work Environment: Remote Eligible • Must be willing to work core business hours of 8 AM - 5 PM Central Time. • This role is remote eligible and will require candidates to provide high-speed internet at their home work location.