Lead analysis and configuration of complex medical policy content and system edits within claims processing systems to ensure compliance and accurate claims adjudication.
Serve as a coding subject matter expert, translating policy language into actionable criteria, resolving coding-related issues, and mentoring Coding Specialists and operational partners.
Maintain system infrastructure and coding integrity, conduct impact analyses, and participate in cross-functional initiatives to manage medical benefit expense and support organizational goals.
Wellmark is a mutual insurance company owned by its policyholders across Iowa and South Dakota, focused on member well-being and best-in-class service rather than profits. It is a substantial organization with over 80 years of history, fostering a culture of sustainability, innovation, and collegiality.
Partner with physician offices to translate healthcare documentation into standardized codes, ensuring accurate billing and regulatory compliance.
Conduct audits and issue queries to clarify ambiguous documentation, and provide ongoing education to clinical staff on best practices.
Analyze complex medical records, stay updated on coding guidelines, and collaborate with departments like compliance and revenue cycle to optimize processes.
Evergreen Nephrology partners with nephrologists to deliver value-based, person-centered kidney care aimed at improving patient outcomes and quality of life. The company fosters a collaborative culture focused on innovation and holistic patient support, with a team dedicated to transforming the healthcare delivery model.
Perform complex coding for CPT, HCPCS, and ICD-10 with a focus on high-impact, payer-sensitive services.
Lead expansion and validation of new and underutilized codes, ensuring accurate reimbursement.
Support analysis of coding-related denials and rejections, identifying root causes and driving upstream fixes.
Cartwheel is building a mental health program for kids that puts schools at the center, collaborating with school staff to provide earlier intervention and better coordination. They are backed by top investors and are looking for mission-driven teammates to join their team.