Wellmark, Inc.
Insurance
MedicalPolicy&CodingSupportCoordinator
“Medical Policy & Coding Support Coordinator at Wellmark, Inc.. Skills: medical coding, claims, provider payment, system configuration, operational support, coding analysis, utilization reporting. supporting medical policy functions. providing medical coding support”
What You'll Achieve.
adhere to quality and production metrics; ensure accuracy and consistency in all operations and deliverables; ensure that all documentation related to health policy decisions, changes, implementations, and communications are complete, accurate, and timely.
Industry & Context.
developing thoughtful solutions; critical thinking and decision-making effectively identifies, researches, tests, and analyzes issues; Thinks up and down stream to effectively manage deliverables
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 home work location., May be asked to come into the office occasionally for specific meetings or other ‘moments that matter’.
What They're Looking For.
Must Have
High school diploma or GED, 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., Detail-oriented with the ability to ensure accuracy and consistency in all operations and deliverables., customer service and communication skills to respond to inquiries in a timely and professional manner., organizational and project management skills, with the ability to manage multiple tasks and deadlines effectively., Ability to handle administrative tasks such as filing external appeals and supporting various team functions as assigned., critical thinking and decision-making effectively identifies, researches, tests, and analyzes issues., written and verbal communication skills with the ability to express complex concepts clearly and concisely., Has demonstrated the ability to obtain relevant information by relating and comparing data from different sources., Ability to adhere to quality and production metrics. Demonstrates commitment to accuracy, quality, timeliness, organization, and attention to details., Self-starter with workflow management skills. Thinks up and down stream to effectively manage deliverables., Proficient with MS Office.
Nice to Have
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) or Certified Professional Coder-Apprentise (CPC-A)., Auditing expereince, such as data comparison, validating discrepancies and reconciling differences.
What You'll Do.
supporting medical policy functions
providing medical coding support
providing system configuration support
providing administrative support
providing operational support
performing coding analyses
performing utilization reporting
recommending updates to medical policies
recommending updates to system configuration
creating and managing monthly Medical Policy production timelines
creating and managing quarterly production timeline for N/R/D Code processing
maintaining Medical Policy material distribution lists
filing external appeals
verifying monthly authorization table updates
tracking performance metrics
supporting virtual monthly Medical Policy Committee (MPC) operations
taking minutes for MPC meetings
developing MPC agenda PowerPoints
circulating MPC agenda PowerPoints
presenting MPC agenda PowerPoints
supporting the Medical Policy Implementation Committee (MPIT)
preparing information for MPIT
sending information to MPIT
generating post-policy discussion documents
performing initial research on impact of changes in vendor and BCBSA Reference Medical Policy changes
performing initial research on opportunities for new policy development
monitoring Medical Policy inbox
triaging Medical Policy inbox
creating SharePoint forms for internal inquiries
performing monthly medical policy coding analyses
generating SAP BusinessObjects reports
identifying necessary changes based on comparison to BCBSA reference medical policies
identifying necessary changes based on comparison to sentinel commercial health plan benchmarks
identifying necessary changes based on comparison to utilization patterns
implementing claim system edits
testing health policy coding requirements
documenting health policy coding requirements
auditing health policy coding requirements
updating system configurations
ensuring accurate administration of health policies
updating coding files
updating health policy revisions
updating regulatory requirements
updating other internal processes
How You'll Work.
Team & Collaboration
participate in cross-functional meetings; align with enterprise strategic priorities; contribute to the overall success of the Medical Policy Team's operations; partner with the coding specialist role; support Medical Policy leadership; participate in cross-functional meetings or initiatives
Communication Scope
effective communicator; customer service and communication skills to respond to inquiries in a timely and professional manner; written and verbal communication skills with the ability to express complex concepts clearly and concisely
Process & Methodology
managing multiple tasks and deadlines effectively, workflow management
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