Hybrid Clinical Payment Policy Analyst

Wellmark, Inc.; Iowa; Híbrido; USD 70.000 - 90.000; Tempo integral

Benefícios oferecidos por esta vaga

Hybrid work arrangement

Resumo da vaga

Wellmark, Inc. is seeking a Payment Policy Analyst - Clinical to join our Payment Integrity team in a hybrid Des Moines, IA environment. You will research and analyze provider payment policies, review claims, and translate clinical information into actionable insights for stakeholders.

Ideal candidates will be curious, analytical, and detail-oriented, with coding knowledge and the ability to interpret medical policies. Collaborative and adaptable teammates are encouraged to apply.

Qualificações

• Active and unrestricted LPN or RN license in IA or SD.
• Coding certification (CPC, CPC-P, COC, CCS-P, RHIT, RHIA) or ability to obtain within 6 months.
• Strong communication, written and verbal, with diverse audiences.
• Ability to interpret medical policies and codes and apply analytical knowledge.
• Experience with research, data analysis, and healthcare regulations.

Responsabilidades

• Develop and maintain payment policies using credible sources and clinical information.
• Monitor healthcare trends and regulations to inform policy education and recommendations.
• Review provider payment claims daily for reasonableness and accuracy.
• Collaborate with stakeholders to enhance provider payment policies and processes.
• Update coding files per revisions and regulatory requirements.
• Support system upgrades and process documentation.

Conhecimentos

RN License Iowa/SD

LPN License Iowa/SD

Coding Certification

Regulatory knowledge

Data interpretation

Communication skills

Time management

HROR familiarity

Microsoft Office

Formação

Associate degree or related work experience

Ferramentas

Microsoft Office

Descrição da vaga

Wellmark, Inc. is seeking a Payment Policy Analyst - Clinical to join our Payment Integrity team in a hybrid Des Moines, IA environment. You will research and analyze provider payment policies, review claims, and translate clinical information into actionable insights for stakeholders.

Ideal candidates will be curious, analytical, and detail-oriented, with coding knowledge and the ability to interpret medical policies. Collaborative and adaptable teammates are encouraged to apply.