Clinical Payment Policy Analyst - Hybrid (LPN/RN)

Wellmark; Des Moines (IA); Hybrid; USD 70,000 - 90,000; Full time

Job summary

Wellmark in Des Moines, IA is seeking a Payment Policy Analyst - Clinical (LPN or RN required) to join our Payment Integrity team. This full-time role reviews provider claims, medical records, and policy documentation to research issues, develop recommendations, and support policy improvements.

The ideal candidate is curious, detail-oriented, and collaborative, with licensure in IA/SD, coding certification or ability to obtain, and strong MS Office skills.

Qualifications

• Associate degree or direct and applicable work experience.
• LPN/Licensed in IA or SD or RN in IA or SD (license in state of residence).
• Coding certification (CPC, CPC-P, COC, CCS-P, RHIT, RHIA) or ability to obtain within 6 months.
• Identify issues or inconsistencies; relate and compare data from different sources.
• Understand regulatory/accreditation standards and data file/system upgrade guidelines.
• Communicate effectively and professionally, verbally and in writing.
• Demonstrate critical thinking, problem solving and process improvement to support policy recommendations.
• Time management and prioritization; flexible to change.
• MS Office proficiency; quick software learning capability.
• Work independently and in teams; positive stakeholder relationships.
• Interest in mentoring others; HROR proficiency preferred.

Responsibilities

• Research, analyze, develop, maintain, coordinate, and document payment policies.
• Monitor healthcare trends, publications and regulations to provide education and recommendations.
• Review provider payment claim reports daily for reasonableness and trends; document issues.
• Collaborate with policy vendor and stakeholders to enhance payment policies and achieve savings.
• Research and resolve high-complexity claims and provider inquiries.
• Update coding files per code set revisions, policy development, regulatory requirements.
• Support system conversions/releases and provide implementation documentation.
• Other duties as assigned.

Skills

LPN/RN license

Coding cert

Regulatory knowledge

Communication

Critical thinking

Time management

Microsoft Office

Independent work

Mentoring

HROR knowledge

Education

Associate degree

Job description

Wellmark in Des Moines, IA is seeking a Payment Policy Analyst - Clinical (LPN or RN required) to join our Payment Integrity team. This full-time role reviews provider claims, medical records, and policy documentation to research issues, develop recommendations, and support policy improvements.

The ideal candidate is curious, detail-oriented, and collaborative, with licensure in IA/SD, coding certification or ability to obtain, and strong MS Office skills.