Senior Claims Configuration & Coding Analyst

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

Benefits offered by this job

PTO from day 1

Retirement plan with company match

Career development opportunities

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, contracts, and coding rules into precise system configurations to ensure accurate claims adjudication.

In this in-person role at our Sioux Falls location, you will collaborate with Operations, Clinical Services, Compliance, IT, and vendors to maintain coding integrity, apply regulatory updates, and optimize

Qualifications

• Ability to translate business requirements into system configuration.
• Experience with ICD-10-CM, CPT, HCPCS, and NCCI edits.
• Experience with health plan claims adjudication and provider reimbursement.
• Strong analytical and documentation skills.
• Ability to work independently and in cross-functional teams.

Responsibilities

• Design, configure, implement, test, and maintain health plan claims systems.
• Translate EOCs/SBCs/contracts into compliant configuration specs.
• Configure and maintain claims editing logic and coding rules (ICD-10-CM, CPT, HCPCS, NCCI).
• Perform end-to-end testing and QA of configuration changes.
• Investigate and resolve processing issues and discrepancies.
• Implement coding updates and regulatory changes (CMS/HIPAA/ACA).
• Develop configuration docs, test plans, and audit trails.
• Collaborate with stakeholders to translate requirements into solutions.
• Serve as SME for claims configuration and system functionality.

Skills

Critical thinking

Effective communication

Independent work

Education

Certified Coding Associate (CCA)

Certified Professional Coder (CPC)

Certified Coding Specialist (CCS)

Epic Certification (Tapestry)

Bachelor's in Healthcare Administration, Information Systems, or related field

Tools

Epic Chronicles

Epic Tapestry

EDI formats (834/837/835)

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, contracts, and coding rules into precise system configurations to ensure accurate claims adjudication.

In this in-person role at our Sioux Falls location, you will collaborate with Operations, Clinical Services, Compliance, IT, and vendors to maintain coding integrity, apply regulatory updates, and optimize