Health Services Coding Analyst (CPC Required)
Remote · Des Moines, Iowa, United States
Job Summary
Health Services Coding Analyst to lead analysis of the most complex Wellmark medical policy content and implementation of system edits to support its intent. Responsibilities include researching and translating medical policy language into precise coding criteria for claims systems, configuring PGE rules and FACETS edits, auditing outcomes, mentoring Coding Specialists, and providing policy-related training to operational partners. The role encompasses cross-functional collaboration with Utilization Management, Medical Directors, Claims, Customer/Provider Services, and data analytics teams to resolve coding denials, support policy interpretation, and ensure compliance with regulatory standards. Remote-eligible with potential in-office visits as needed; strong emphasis on coding expertise, policy configuration, and cross-team leadership.
Required Qualifications
- Associate degree or direct and applicable work experience preferred
- Certified Professional Coder (CPC) required
- Clinical background in health-related discipline or health care setting
- 7+ years’ related health care experience in provider payment, claims, medical coding, or similar
- Demonstrated expertise in medical coding and terminology
- Strong attention to detail and ability to multitask
- Strong communication skills (written and verbal)
- Experience with Microsoft Office (spreadsheets, process mapping, presentations, word processing)
- Ability to adhere to quality and production metrics
- Mentoring/training Coding Specialists
- Remote work eligibility with potential in-office meetings as needed
- Experience with policy development, PGE rules, and coding configuration
- Familiarity with AMA CPT, ICD10, HCPCS
- Ability to translate medical policy language into coding criteria
- Capability to collaborate with Utilization Management and other teams
- Knowledge of regulatory and accreditation requirements
Apply with one swipe on Sorce. We auto-fill applications and apply on your behalf — no cover letters, no 40-minute forms.
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.