Health Services Coding Analyst (CPC Required)
Remote · Iowa, United States or South Dakota, United States
Job Summary
Health Services Coding AnalystLead the analysis and implementation of complex Wellmark medical policy content and PGE rules within claims systems (FACETS/STAR), including coding configuration, testing, documentation, and auditing. Serve as a subject-matter expert in medical policy coding, mentor Coding Specialists, and partner with Utilization Management, medical directors, and claims/customer services to resolve coding-related denials and policy interpretation questions. Translate policy language into actionable coding criteria, support end-to-end policy lifecycle, monitor coding integrity and utilization trends, and collaborate with data analytics and vendor-edit teams to implement edits. The role requires CPC certification, 7+ years of healthcare coding experience, strong attention to detail, excellent written and verbal communication, and the ability to work remotely with core hours 8 AM–5 PM Central Time; location preferred in Iowa or South Dakota.
Required Qualifications
- Certified Professional Coder (CPC) required
- Associate degree or direct and applicable work experience preferred
- Clinical background in health-related discipline (nursing, medical assisting, surgical tech, health information management) or related healthcare experience
- 7+ years’ or related health care experience in provider payment, claims, medical coding, or similar
- Demonstrated expertise in medical coding and terminology
- Strong communication and interpersonal skills, ability to convey complex concepts
- Proficiency with Microsoft Office, data analysis, process mapping, and documentation
- Ability to adhere to quality and production metrics
- Mentor and train Coding Specialists; provide topic training on medical policy administration/PGE rules
- Remote eligible with potential in-office meetings as needed
- Compliance with regulatory and accreditation standards
Additional Requirements
- No immigration sponsorship now or in the future to work in the United States
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.