Claims Configuration & Coding Analyst

Sioux Center Health; Sioux Falls (SD); On-site; USD 64,000 - 96,000; Full time

Benefits offered by this job

PTO from day 1

Employer matching retirement up to 5%

Career development and mentorship

Job summary

Avera Health Plans is seeking a Configuration & Coding Analyst to design, configure, implement, and support health plan claims administration systems, ensuring accurate, compliant, and automated adjudication.

The role requires translating benefit plans, provider contracts, and regulatory requirements into system configurations, maintaining coding integrity, and collaborating with multiple stakeholders for ongoing system optimization.

Qualifications

• Must hold AHIMA/CPC/CCS certifications upon hire.
• Epic Certification required or must pass Epic coursework within 90 days of hire.
• 4-6 years coding experience with knowledge of provider reimbursement methodologies.

Responsibilities

• Design, configure, implement, test, and maintain health plan claims administration systems and workflows.
• Translate EOCs, SBCs, provider contracts, and policies into compliant system configurations.
• Configure and maintain claims editing software and coding logic (ICD-10-CM, CPT, HCPCS, NCCI).
• Perform end-to-end testing and QA of configuration changes for accurate adjudication.
• Investigate and resolve claims processing issues and coding discrepancies.
• Stay updated on coding reimbursement methodologies and regulatory requirements (CMS, HIPAA, NCQA).
• Develop and maintain configuration docs, testing plans, and audit trails.
• Collaborate with cross-functional teams to translate business requirements into system solutions.
• Serve as SME for claims configuration and health plan system functionality.

Skills

Critical thinking

Cross-functional collaboration

Problem-solving

Attention to detail

Education

CCA - AHIMA

CPC - AAPC

CCS - AHIMA

Epic Certification

4-6 years coding experience

Bachelor's in Healthcare Administration or related field

Epic Tapestry Certification (Preferred)

Tools

Epic Chronicles

EDI formats (834, 837, 835)

Job description

Avera Health Plans is seeking a Configuration & Coding Analyst to design, configure, implement, and support health plan claims administration systems, ensuring accurate, compliant, and automated adjudication.

The role requires translating benefit plans, provider contracts, and regulatory requirements into system configurations, maintaining coding integrity, and collaborating with multiple stakeholders for ongoing system optimization.