Configuration and Coding Analyst
$63,960–$96,200 year
On-siteSioux Falls, South Dakota, United States
Job Summary
Design, configure, implement, test, and maintain health plan claims administration systems to ensure accurate, compliant, and automated claims adjudication. Translate benefit plans, provider contracts, and regulatory requirements into system configuration for claims editing software, including ICD-10-CM, CPT, HCPCS, and reimbursement rules. Perform end-to-end testing, validate claims processing logic, and troubleshoot configuration issues to resolve payment discrepancies and denied claims. Research and implement quarterly updates to medical coding and payer policies while maintaining configuration documentation and audit trails. Collaborate with Health Plan Operations, Clinical Services, and IT to support continuous system optimization and enterprise initiatives.
Required Qualifications
- Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA) or other nationally recognized coding organization Upon Hire
- Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) Upon Hire
- Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA) Upon Hire
- Epic Certification - Epic Epic Tapestry Certification or required to participate in Epic coursework and pass certification exams within 90 days of hire
- 4-6 years Coding with knowledge and understanding of provider reimbursement methodologies, medical terminology, human anatomy, physiology, ICD-10-CM, CPT, HCPCS coding, and NCCI edits
- Demonstrated critical thinking skills through evaluation, analysis, and creative solutions
- Ability to think broadly, identifying and understanding implications to the entire organization including excellent communication, documentation and problem-solving skills
- Ability to work independently and as part of a cross-functional team
- Visual acuity adequate to perform position duties
- Ability to communicate effectively with others
- Ability to hear, understand and distinguish speech and other sounds
- Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)
- Experience with Epic Chronicles and data models, Care Management or other related modules
- Familiarity with EDI (Electronic Data Interchange) formats (e.g., 834, 837, 835) and integration best practices
Desired Qualifications
- Bachelor's in Healthcare Administration, Information Systems, or related field
- Epic Tapestry Certification with 3+ years of experience
- Experience with complex system design
- Preferred experience with claims adjudication platforms or ecosystems, specifically Epic Tapestry
- Background and knowledge of Health Plans operations and understanding of health plan processes, systems and regulations including claims processing, benefit configuration, enrollment and provider networks
- Including familiarity with CMS regulations, HIPAA and payer-provider contracting
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