Health Services Coding Analyst (CPC Required)

Company Description: Why Wellmark : We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today! Learn more about our unique benefit offerings here. Job Description: As a Health Services Coding Analyst, you will 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. You will 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. To do this, you will research and analyze system and business issues, develop high-level requirements, test and implementsolutions, and audit and document outcomes. The Health Services Coding Analyst also serves 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. Must be willing to work core business hours of 8 AM - 5 PM Central Time. Candidates located in Iowa or South Dakota preferred. This role is remote eligible and will require candidates to provide high-speed internet at their work location. Qualifications: Preferred Qualifications - Great to have:

• Prior health plan experience.

Required Qualifications - Must have:

• 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.

Additional Information: What you will do: a. Leadership in Coding Analysis: Lead the analysis of the most complex Wellmark medical policy content and implementation of system edits to support its intent. Medical policy coding requirements are implemented, tested, documented and audited to assure compliance. b. Maintain the claims processing system infrastructure to ensure compliance with regulatory and accreditation bodies and vendor supported technical requirements and ensure accurate claims adjudication. c. Translate complex medical policy language into precise, actionable coding criteria for integration into claims systems and configuration platforms. d. Serve as coding subject matter expert for complex or escalated utilization management. e. Collaborate with Utilization Management nurses, medical directors, and claims teams to resolve coding-related denials, overrides, and policy interpretation questions. f. Contribute to the full lifecycle of medical policy creation, revision and interim review, including drafting coding sections, researching emerging procedures/devices, and ensuring policies reflect current coding conventions (AMA CPT, ICD10, HCPCS). g. Conduct impact analyses of proposed Apply tot his job Apply To this Job