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, including Plan General Exclusion (PGE) rules and FACETS table maintenance.
You will ensure the accurate implementation of medical policies, review criteria, and authorization requirements while maintaining system integrity and serving as a liaison between business and technical teams. The role includes researching and analyzing system and business issues, developing high-level requirements, testing and implementing solutions, and auditing and documenting outcomes.
You will also serve as an expert resource for medical policy configuration and PGE coding, mentor and train Coding Specialists, and provide policy-related training and support to operational partners such as customer and provider services.
This position is remote eligible and may require occasional office حضور for specific meetings or other key moments.
Preferred qualifications
- Prior health plan experience
Required qualifications
- Associate degree or direct and applicable work experience preferred
- Certified Professional Coder (CPC) required
- Clinical background through formal education or training in a clinical or 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
- Strong interpersonal, written, and verbal communication skills
- Ability to develop and implement new processes
- Strong workflow management skills with ownership, drive, and initiative
- Ability to communicate clearly to individuals and groups and help motivate others
- Ability to gather and compare information from different sources
- Proficiency in Microsoft Office applications, including spreadsheets, process mapping, presentations, and word processing
- Ability to meet quality and production metrics
- Experience coaching and mentoring others
- Ability to consistently meet the department work schedule
Perks and employment details
- Remote eligible / fully remote option
- Flexible work location
- Core business hours: 8 AM - 5 PM Central Time
- Potential occasional office visits for key meetings
- Employer supports responsible use of AI tools by job seekers and employees
Location
Iowa, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
Yes
Posted
2 weeks ago