Wellmark, Inc.
Insurance
HealthServicesCodingAnalyst(CPCRequired)
“Health Services Coding Analyst (CPC Required) at Wellmark, Inc.. Skills: Medical policy, Claims processing, Medical coding, System configuration. Lead analysis of medical policy content. Implement system edits”
What You'll Achieve.
Ensure accurate claims adjudication; Continuously improve outcomes
Industry & Context.
System issue analysis; Business issue analysis; Problem resolution
Work core business hours, Provide high-speed internet
What They're Looking For.
Must Have
Associate degree or applicable work experience, Certified Professional Coder (CPC) required, Clinical background or direct healthcare experience, 7+ years healthcare experience, Expertise in medical coding and terminology, Attention to detail, Ability to multitask, Interpersonal skills, Clear and concise written communication, Clear and concise verbal communication, Inquisitive nature, Workflow management skills, Sense of ownership, Drive and initiative, Ability to communicate concepts clearly, Ability to communicate concepts concisely, Motivate others to achieve success, Promote collegiality and excellence, Obtain relevant information by relating data, Proficiency in Microsoft Office, Experience with spreadsheets, Experience with process mapping, Experience with presentation software, Experience with word processing, Adhere to quality metrics, Adhere to production metrics, Experience with coaching others, Interest in coaching others, Consistently meet department work schedule
Nice to Have
Prior health plan experience, Candidates located in Iowa or South Dakota
What You'll Do.
Lead analysis of medical policy content
Implement system edits
Assure compliance with coding requirements
Test coding requirements
Document coding requirements
Audit coding requirements
Maintain claims processing system infrastructure
Ensure compliance with regulatory bodies
Ensure compliance with accreditation bodies
Ensure compliance with vendor technical requirements
Ensure accurate claims adjudication
Translate medical policy language
Create actionable coding criteria
Integrate criteria into claims systems
Integrate criteria into configuration platforms
Serve as coding subject matter expert
Resolve utilization management issues
Collaborate with nurses
Collaborate with medical directors
Collaborate with claims teams
Resolve coding-related denials
Resolve coding-related overrides
Resolve policy interpretation questions
Contribute to medical policy creation
Contribute to medical policy revision
Conduct impact analyses
Provide medical coding expertise
Provide PGE rule knowledge
Resolve complex claims issues
Resolve customer issues
Resolve provider issues
Maintain coding integrity
Monitor utilization trends
Identify system configuration issues
Resolve system configuration issues
Develop coding configuration standards
Optimize coding configuration standards
Develop coding best practices
Implement Optum edits
Implement Cotiviti edits
Implement Cognizant edits
Serve as primary points of contact
Provide expertise to claims processing systems
Support table maintenance
Support regulatory requirements
Support FEP guidelines
Support Blue Card guidelines
Support internal processes
Participate in cross functional meetings
Participate in initiatives
Manage medical benefit expense
Consult with leadership on business decisions
Retain documentation of decisions
Archive documentation of decisions
Comply with regulatory standards
Comply with accreditation standards
Comply with internal standards
Remain current with standards
Remain consistent with standards
Mentor Coding Specialists
Train Coding Specialists
Provide policy administration training
Provide PGE rules training
Provide training to operational areas
How You'll Work.
Team & Collaboration
Business and technical teams; Utilization Management nurses; Medical directors; Claims teams; Health Services leadership; Medical Review staff; Claims leadership; Customer Services leadership; Provider Services leadership; Network Engagement leadership; Payment integrity teams; Business support teams; Data analytics teams; UM Product Team; Cross functional meetings
Communication Scope
Written communication; Verbal communication; Concept communication
Applying for this Health Services Coding Analyst (CPC Required) role?
Most applicants get filtered before a human reads their resume. See if yours makes the cut.
How to Apply on SmartRecruiters
- SmartRecruiters often includes a video screening step — check camera and mic permissions.
- Link your GitHub or portfolio directly in the profile section for technical roles.
- Applications may be reviewed by AI scoring before reaching a recruiter — use keywords from the job description.
ANONYMOUS · UNFILTERED
What do employees actually say about Wellmark, Inc.?
Real rants from real employees. Read before you apply.