Wellmark, Inc.
Insurance
MedicalPolicy&CodingSupportCoordinator(CPC/CPCApreferred)
“Medical Policy & Coding Support Coordinator (CPC/CPC-A preferred) at Wellmark, Inc.. Skills: Medical coding, Claims analysis, System configuration, Policy analysis, Operational support. Supporting medical policy functions. Providing medical coding support”
What You'll Achieve.
Adhere to quality and production metrics.; Demonstrates commitment to accuracy, quality, timeliness, organization, and attention to details.
Industry & Context.
Skilled at developing thoughtful solutions based on your medical coding experience and critical thinking skills.; Critical thinking and decision-making effectively identifies, researches, tests, and analyzes issues.; Has demonstrated the ability to obtain relevant information by relating and comparing data from different sources.
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.
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
Managing quarterly production timeline for N/R/D Code processing
Maintaining Medical Policy material distribution lists
Filing external appeals
Verifying monthly authorization table updates align with quality expectations
Tracking performance metrics
Supporting virtual monthly Medical Policy Committee (MPC) operations
Taking minutes for MPC meetings
and presenting agenda PowerPoints for MPC meetings
Supporting the Medical Policy Implementation Committee (MPIT)
Preparing and sending information to MPIT
Generating post-policy discussion documents
Initial research on impact of changes in vendor and BCBSA Reference Medical Policy changes
Initial research on opportunities for new policy development
Monitoring and triaging Medical Policy inbox for external inquiries
Creating SharePoint forms for internal inquiries
Performing monthly medical policy coding analyses
Generating SAP BusinessObjects reports
Identifying and recommending necessary changes based on comparison to BCBSA reference medical policies
sentinel commercial health plan benchmarks and utilization patterns
Implementing claim system edits to support policy intent
Testing health policy coding requirements
Documenting health policy coding requirements
Auditing health policy coding requirements
Ensuring documentation related to health policy decisions
and communications are complete
Updating system configurations to ensure accurate administration of health policies
Updating system configurations for changes related to coding file updates
health policy revisions
regulatory requirements or other internal processes
Other duties as assigned
How You'll Work.
Team & Collaboration
Participate in cross-functional meetings to align with enterprise strategic priorities; Contribute to the overall success of the Medical Policy Team's operations; Partner with the coding specialist role in the support of the Medical Policy Implementation Committee (MPIT); Support Medical Policy leadership; Participate in cross-functional meetings or initiatives to support the enterprise strategic priorities
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
Organizational and project management skills, with the ability to manage multiple tasks and deadlines effectively., Workflow management skills.
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