Wellmark Blue Cross and Blue Shield is a mutual insurance company serving Iowa and South Dakota with over 80 years of trusted service, focused on member well-being rather than profits.

As a Health Services Coding Analyst, you provide clinical leadership and expert knowledge to analyze, configure, and administer complex medical policy content within claims processing systems, including Plan General Exclusion (PGE) rules and FACETS table maintenance. You ensure the accurate implementation of medical policies, review criteria, and authorization requirements while maintaining system infrastructure integrity. You will also act as a liaison between business and technical teams, researching and analyzing issues, developing requirements, testing and implementing solutions, auditing, and documenting results. Additionally, you mentor and train Coding Specialists and provide policy-related training to operational partners such as customer and provider services.

This role requires working 8 AM - 5 PM Central Time. Candidates located in Iowa or South Dakota are preferred. The position is remote eligible, requiring a high-speed internet connection.

Qualifications:

Associate degree or equivalent applicable experience preferred.
Certified Professional Coder (CPC) required.
Clinical background through education or experience in nursing, medical assisting, surgical technology, health information management, or related fields.
7+ years of healthcare experience in provider payment, claims, medical coding, or similar areas.
Expertise in medical coding and terminology.
Strong attention to detail and multitasking ability.
Excellent interpersonal, verbal, and written communication skills.
Enthusiasm for process improvement and workflow management.
Ability to convey concepts clearly and motivate teams.
Skilled in Microsoft Office including spreadsheets, process mapping, and word processing.
Commitment to quality, meeting metrics, and coaching others.

Responsibilities:

Lead analysis of complex medical policy content and coding requirements.
Maintain claims processing systems for compliance and accurate adjudication.
Translate medical policy language into actionable coding criteria.
Serve as coding expert for complex utilization management cases.
Collaborate with medical and claims teams to resolve coding-related issues.
Contribute to medical policy lifecycle including coding sections and research.
Assess impacts of policy changes on coding and reimbursement.
Provide expertise across claims processing systems and regulatory compliance.
Monitor and maintain coding integrity and system configuration.
Develop coding standards and best practices with leadership.
Participate in cross-functional teams and training initiatives.
Mentor and train Coding Specialists and provide operational support training.
Other duties as assigned.

Remote work is fully eligible with occasional office visits possible. Equal Opportunity Employer committed to diversity and inclusion.

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