Claims Systems Config & Coding Expert

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

Benefits offered by this job

PTO day 1

Retirement matching

Career development mentorship

Job summary

Avera Health Plans is seeking a Configuration & Coding Analyst to design, configure, implement, test, and support health plan claims administration systems. You will translate benefit plans, provider contracts, reimbursement methodologies, and regulatory requirements into robust system configurations to support accurate, automated claims adjudication.

In this role, you will validate coding and pricing logic, maintain edits (ICD-10-CM, CPT, HCPCS, NCCI), and collaborate across Health Plan

Qualifications

• Critical thinking demonstrated through evaluation, analysis and creative solutions.
• Excellent communication, documentation and problem-solving skills.
• Ability to work independently and as part of a cross-functional team.
• Epic Tapestry Certification or willing to pass within 90 days of hire.
• 4-6 years coding with provider reimbursement knowledge and regulatory understanding.

Responsibilities

• Design, configure, implement, test, and maintain health plan claims administration systems and related workflows.
• Translate EOC/SBCs, provider contracts and regulations into compliant system configurations.
• Configure and maintain claims editing software and coding logic (ICD-10-CM, CPT, HCPCS, NCCI, etc.).
• Perform end-to-end testing and QA of system configuration changes.
• Investigate, troubleshoot, and resolve claims processing issues and misconfigurations.
• Research and implement quarterly updates to coding and regulatory requirements.
• Develop and maintain configuration documentation, testing plans, and audit trails.
• Collaborate with Health Plan Operations, Clinical Services, Provider Network, Compliance, IT and vendors.
• Serve as SME for claims configuration and system functionality; support upgrades and production issues.

Skills

Critical thinking

Communication

Documentation

Problem-solving

Education

CCA Certification

CPC Certification

CCS Certification

Epic Tapestry Certification

Bachelor’s degree in Healthcare Administration or Information Systems

Tools

Epic Chronicles

Job description

Avera Health Plans is seeking a Configuration & Coding Analyst to design, configure, implement, test, and support health plan claims administration systems. You will translate benefit plans, provider contracts, reimbursement methodologies, and regulatory requirements into robust system configurations to support accurate, automated claims adjudication.

In this role, you will validate coding and pricing logic, maintain edits (ICD-10-CM, CPT, HCPCS, NCCI), and collaborate across Health Plan