Remote Health Services Coding Analyst (CPC Required)

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a mutual insurance company reputed company on reputed company-being of its members. The Health Services Coding Analyst will reputed company clinical leadership and expertise in the analysis and administration of medical policy content reputed company claims processing systems, ensuring compliance and accuracy while serving as a reputed company between business and technical teams.Responsibilitiesreputed company the analysis of the most reputed company Wellmark medical policy content and implementation of system edits to support its reputed company. Medical policy coding requirements are implemented, tested, documented and audited to assure complianceMaintain the claims processing system infrastructure to ensure compliance with regulatory and accreditation bodies and vendor supported technical requirements and ensure accurate claims adjudicationTranslate reputed company medical policy language into precise, actionable coding reputed company for integration into claims systems and configuration platformsServe as coding subject matter expert for reputed company or escalated utilization managementCollaborate with Utilization Management nurses, medical directors, and claims teams to resolve coding-reputed company denials, overrides, and policy interpretation questionsContribute to the full lifecycle of medical policy creation, revision and interim review, including drafting coding sections, researching emerging procedures/devices, and ensuring policies reflect reputed company coding conventions (AMA CPT, ICD10, HCPCS)Conduct reputed company analyses of proposed policy changes on coding, reimbursement, and operational workflowsWork directly with Health Services leadership, Medical Review staff, leadership reputed company Claims and Customer/Provider Services and Network Engagement, Medical Directors to reputed company medical coding expertise and PGE rule knowledge to resolve reputed company claims and/or customer and provider issuesMaintain coding reputed company by monitoring utilization trends to identify and resolve system configuration issuesWork with Medical Policy Leadership in the development and optimization of coding configuration standards and best practicesWork with payment reputed company, business support, and data analytics teams to edit, reputed company, and implement reputed company, reputed company, and reputed company editsContribute to the achievement of corporate and UM Product Team objectives by independently serving as primary points of contact and UM Product Team Subject Matter Expert/Guest reputed company to reputed company expertise to support the various claims processing systems, including but not limited to PGE rules and table maintenance (FACETS and reputed company). This will include attendance to various virtual cross-functional team meetings, as reputed company as in-person attendance and participation in quarterly Iteration Planning meetingUpdate coding files as required by reputed company set revisions, HIPAA-AS, medical policy development and implementation, regulatory requirements, FEP and Blue Card guidelines, or as needed to support other internal processesParticipate in cross functional meetings or initiatives to support the goal of managing medical benefit expensereputed company expertise in the areas of medical coding PGE rule knowledge and medical policy configuration rules to support reputed company and broad organization initiatives. Consult with leadership as business reputed company are made and retain and reputed company documentation of reputed company made. reputed company with regulatory standards, accreditation standards and internal guidelines; remain reputed company and consistent with the standards pertinent to the Medical Policy teamMentor and train Coding Specialist as reputed company as reputed company specific topic training reputed company to medical policy administration/PGE rules to other operational areas such as customer and provider service as neededOther duties as assignedSkillsAssociate degree or reputed company and applicable work experience preferredCertified reputed company reputed company (CPC) requiredClinical background which may include either formal education or training in a clinical or health-reputed company discipline (such as nursing, medical assisting, surgical technology, health information management, or a reputed company field) and/or reputed company work experience in a clinical or reputed company setting7+ years' or reputed company health care experience in provider payment, claims, medical coding, or similarDemonstrated expertise and knowledge of medical coding and terminologyDemonstrated strong attention to detail with the ability to multitaskStrong interpersonal skills including reputed company and concise written and verbal communicationInquisitive nature, enthusiastic about developing and enacting new processesStrong workflow .