Medical Policy & Coding Support Coordinator (CPC/CPC-A preferred)

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

Use Your Strengths at Wellmark! 

About the role: As a Medical Policy & Coding Support Coordinator, you will play a key role in supporting medical policy functions by providing medical coding, system configuration, and administrative and operational support. Using your medical coding knowledge, you will also perform coding analyses and utilization reporting to recommend necessary updates to medical policies and system configuration. You will participate in cross-functional meetings to align with enterprise strategic priorities and contribute to the overall success of the Medical Policy Team's operations. 

About you: You are experienced in provider payment, claims and/or medical coding. You are an effective communicator, naturally inquisitive and are skilled at developing thoughtful solutions based on your medical coding experience and strong critical thinking skills. You are a self-starter who thrives in a highly autonomous work environment where your time management, administrative, prioritization, and organizational skills are critical to success. You are resourceful and detail-oriented, with a high degree of quality control in your work. Technology savviness is a must. Top candidates will have their CPC or CPC-A, along with recent direct coding application/interpretation work.

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.  

Qualifications

Preferred Qualifications - Great 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.

Required Qualifications - 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.
• Strong customer service and communication skills to respond to inquiries in a timely and professional manner.
• Strong 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.
• Strong critical thinking and decision-making skills; effectively identifies, researches, tests, and analyzes issues.
• Strong 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 strong workflow management skills. Thinks up and down stream to effectively manage deliverables.
• Proficient with MS Office.

Additional Information

What you will do:

a. Support Medical Policy Team’s operations, including creating and managing monthly Medical Policy production timelines, quarterly production timeline for N/R/D Code processing, maintaining Medical Policy material distribution lists, and filing external appeals.

b. Verify that the monthly authorization table updates align with quality expectations and track performance metrics.

c. Support virtual monthly Medical Policy Committee (MPC) operations, including taking minutes, developing, circulating, and presenting agenda PowerPoint during monthly MPC virtual meetings.

d. Partner with the coding specialist role in the support of the Medical Policy Implementation Committee (MPIT), including preparing and sending information to MPIT, and generating post- policy discussion documents.

e. Support Medical Policy leadership in initial research on impact of changes in vendor and BCBSA Reference Medical Policy changes and opportunities for new policy development.

f. Monitor and triage Medical Policy inbox for external inquiries and creating of SharePoint forms for internal inquiries.

g. Perform monthly medical policy coding analyses and SAP BusinessObjects reports to identify and recommend necessary changes based on comparison to BCBSA reference medical policies, sentinel commercial health plan benchmarks and utilization patterns and implementation of claim system edits to support its intent. Health policy coding requirements are implemented, tested, documented, and audited to assure compliance and accuracy.

h. Ensure that all documentation related to health policy decisions, changes, implementations, and communications are complete, accurate, and timely.

i. Update system configurations to ensure accurate administration of health policies including changes related to coding file updates, health policy revisions, FEP, regulatory requirements or other internal processes as needed.

j. Participate in cross-functional meetings or initiatives to support the enterprise strategic priorities.

k. Other duties as assigned.

Remote Eligible: You will have the flexibility to work where you are most productive. This position is eligible to work fully remote. Depending on your location, you may still have the option to come into a Wellmark office if you wish to. Your leader may ask you to come into the office occasionally for specific meetings or other ‘moments that matter’ as well.  

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at careers@wellmark.com

Please inform us if you meet the definition of a "Covered DoD official".

At this time, Wellmark is not considering applicants for this position that require any type of immigration sponsorship (additional work authorization or permanent work authorization) now or in the future to work in the United States. This includes, but IS NOT LIMITED TO: F1-OPT, F1-CPT, H-1B, TN, L-1, J-1, etc. For additional information around work authorization needs please refer to the following resources:Nonimmigrant Workers and Green Card for Employment-Based Immigrants 

Wellmark supports and expects the responsible use of AI for our workforce! We welcome the responsible use of these tools by job seekers as well and are interested in learning from you; you will have an opportunity in the application process to share which tools you used and how you applied them.