Health Services Coding Analyst (CPC Required)

Primary Responsibilities:

• Analyze and configure complex medical policy content, including Plan General Exclusion rules and FACETS table maintenance, to ensure accurate implementation and system compliance.
• Translate medical policy language into precise coding criteria, serve as an expert for utilization management, and collaborate with nurses and medical directors to resolve coding denials.
• Conduct impact analyses of policy changes, maintain coding integrity by monitoring trends, and work with leadership on configuration standards and best practices.

Operational & Collaborative Duties:

• Act as a primary point of contact and subject matter expert for claims processing systems, attending cross-functional meetings to support projects and organizational initiatives.
• Update coding files for code set revisions, HIPAA-AS, regulatory requirements, and internal processes, ensuring compliance with all standards and guidelines.
• Mentor and train Coding Specialists and provide policy-related training to operational areas such as customer and provider services as needed.

Work Environment & Requirements:

• This role is fully remote eligible, requiring high-speed internet, with a preference for candidates in Iowa or South Dakota and core business hours of 8 AM - 5 PM Central Time.
• Compliance with regulatory and accreditation standards is essential, along with retaining documentation of business decisions and supporting a culture of excellence.