Hybrid Clinical Payment Policy Analyst

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

Job summary

Wellmark Blue Cross Blue Shield is seeking a Payment Policy Analyst - Clinical to join the Payment Integrity team in a hybrid Des Moines environment. You will research and document payment policies, analyze claims, and translate clinical information into clear, actionable insights.

The role requires nursing licensure (LPN or RN in IA/SD) or equivalent experience, coding credentials or the ability to obtain them within 6 months, and strong analytical, communication, and mentoring skills.

Qualifications

• Associate degree or equivalent work experience.
• LPN or RN license in IA or SD (active and unrestricted).
• Coding certification (CPC, CPC-P, COC, CCS-P, RHIT, RHIA) or ability to obtain within 6 months.
• Identify issues, relate data from multiple sources, and propose solutions.
• Understand regulatory/accreditation standards and data/file/system upgrades.
• Communicate effectively, verbally and in writing, to varied audiences.
• Time management and ability to prioritize multiple projects.
• Interest in coaching/mentoring others.

Responsibilities

• Research, analyze, develop, maintain, coordinate, and document payment policies using credible sources.
• Monitor healthcare trends and regulations to provide education and policy recommendations.
• Review provider payment claim reports daily for reasonableness and accuracy.
• Collaborate with payment policy vendor and stakeholders to enhance payment policies.
• Research, analyze, monitor, and resolve high-complexity claims and provider inquiries.
• Update coding files in response to code set revisions, policy development, and regulatory needs.
• Support system conversions and release upgrades; assist with implementation and process documentation.
• Perform other duties as assigned.

Skills

Critical thinking

Communication

Time management

Problem solving

Team collaboration

Analytical skills

Detail-oriented

Coaching/mentoring

Education

Associate degree or direct and applicable work experience

Tools

Microsoft Office

Job description

Wellmark Blue Cross Blue Shield is seeking a Payment Policy Analyst - Clinical to join the Payment Integrity team in a hybrid Des Moines environment. You will research and document payment policies, analyze claims, and translate clinical information into clear, actionable insights.

The role requires nursing licensure (LPN or RN in IA/SD) or equivalent experience, coding credentials or the ability to obtain them within 6 months, and strong analytical, communication, and mentoring skills.