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Responsibilities:
- Lead the analysis of medical policy content and implementation of system edits.
- Maintain claims processing system infrastructure to ensure compliance.
- Translate complex medical policy language into coding criteria.
Collaboration:
- Serve as coding subject matter expert for complex utilization management.
- Work with nurses, medical directors, and claims teams to resolve coding-related issues.
- Collaborate on the full lifecycle of medical policy creation and revision.
Support and Training:
- Mentor and train Coding Specialists.
- Provide topic training related to medical policy administration.
- Support projects and organizational initiatives providing coding expertise.
Wellmark Blue Cross Blue Shield
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, built on over 80 years of trust and motivated by member well-being, not profits. They are committed to providing best-in-class service, sustainability, and innovation.