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.