As a Health Services Coding Analyst, you will provide clinical leadership and subject-matter expertise to support the analysis, configuration, and administration of complex medical policy content within claims processing systems. This includes supporting Plan General Exclusion (PGE) rules, FACETS table maintenance, and the accurate implementation of medical policies, review criteria, and authorization requirements.
You will research and analyze system and business issues, develop high-level requirements, test and implement solutions, and audit and document outcomes. The role also serves as an expert resource for medical policy configuration and PGE coding, while mentoring and training Coding Specialists and supporting customer and provider service teams.
This position is eligible for fully remote work. Candidates located in Iowa or South Dakota are preferred. Core business hours are 8 AM to 5 PM Central Time.
- Associate degree or direct, applicable work experience preferred
- Certified Professional Coder (CPC) required
- Clinical background or training in a health-related discipline, or direct work experience in a clinical or healthcare setting
- 7+ years of related healthcare experience in provider payment, claims, medical coding, or similar
- Strong knowledge of medical coding and terminology
- Strong attention to detail and ability to multitask
- Excellent written and verbal communication skills
- Ability to analyze data from multiple sources and identify issues
- Proficiency with Microsoft Office applications, including spreadsheets, process mapping, presentations, and word processing
- Ability to meet quality and production metrics
- Experience coaching or mentoring others preferred
- Ability to consistently meet department work schedules
Location
South Dakota, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
Yes
Posted
2 weeks ago