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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.

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