• Preparation of billing data to be used in the billing of payers • Responsible for complying with contractual provisions regarding billing and encounter data • Submit invoices to agencies • Apply payments and collect on unpaid claims • Prepare advance reconciliations and apply payments to the general ledger • Enter information into computer databases for effective record keeping • Collaborate with other staff members to optimize delivery of services • Ensure all compliance standards are met for audit purposes • Maintain confidentiality of records relating to clients • Identify opportunities to improve processes

Role Description As a Medical Policy & Coding Support Coordinator, you will play a key role in supporting medical policy functions by providing medical coding, system configuration, and administrative and operational support. Using your medical coding knowledge, you will also perform coding analyses and utilization reporting to recommend necessary updates to medical policies and system configuration. You will participate in cross-functional meetings to align with enterprise strategic priorities and contribute to the overall success of the Medical Policy Team's operations. Qualifications - Associate's or bachelor's degree in a relevant field (e.g., health administration, business administration, or a related discipline) - Preferred - Claims experience with knowledge of Facets - Strongly preferred - Familiarity with SAP BusinessObjects - Preferred - Certified Professional Coder (CPC) or Certified Professional Coder-Apprentice (CPC-A) - Preferred - Auditing experience, such as data comparison, validating discrepancies and reconciling differences - Preferred - High school diploma or GED - Required - Certified Professional Coder (CPC) required; must attain the certification within 12 months of hire and maintain throughout employment - Required - 4+ years of experience in provider payment, claims or medical coding; demonstrates coding knowledge – e.g. ICD-10, HCPC, CPT - Required - Detail-oriented with the ability to ensure accuracy and consistency in all operations and deliverables - Required - Strong customer service and communication skills to respond to inquiries in a timely and professional manner - Required - Strong organizational and project management skills, with the ability to manage multiple tasks and deadlines effectively - Required - Ability to handle administrative tasks such as filing external appeals and supporting various team functions as assigned - Required - Strong critical thinking and decision-making skills; effectively identifies, researches, tests, and analyzes issues - Required - Strong written and verbal communication skills with the ability to express complex concepts clearly and concisely - Required - Demonstrated ability to obtain relevant information by relating and comparing data from different sources - Required - Ability to adhere to quality and production metrics; demonstrates commitment to accuracy, quality, timeliness, organization, and attention to details - Required - Self-starter with strong workflow management skills; thinks up and down stream to effectively manage deliverables - Required - Proficient with MS Office - Required Requirements - Support Medical Policy Team’s operations, including creating and managing monthly Medical Policy production timelines, quarterly production timeline for N/R/D Code processing, maintaining Medical Policy material distribution lists, and filing external appeals. - Verify that the monthly authorization table updates align with quality expectations and track performance metrics. - Support virtual monthly Medical Policy Committee (MPC) operations, including taking minutes, developing, circulating, and presenting agenda PowerPoint during monthly MPC virtual meetings. - Partner with the coding specialist role in the support of the Medical Policy Implementation Committee (MPIT), including preparing and sending information to MPIT, and generating post-policy discussion documents. - Support Medical Policy leadership in initial research on impact of changes in vendor and BCBSA Reference Medical Policy changes and opportunities for new policy development. - Monitor and triage Medical Policy inbox for external inquiries and creating of SharePoint forms for internal inquiries. - Perform monthly medical policy coding analyses and SAP BusinessObjects reports to identify and recommend necessary changes based on comparison to BCBSA reference medical policies, sentinel commercial health plan benchmarks and utilization patterns and implementation of claim system edits to support its intent. - Ensure that all documentation related to health policy decisions, changes, implementations, and communications are complete, accurate, and timely. - Update system configurations to ensure accurate administration of health policies including changes related to coding file updates, health policy revisions, FEP, regulatory requirements or other internal processes as needed. - Participate in cross-functional meetings or initiatives to support the enterprise strategic priorities. - Other duties as assigned. Benefits - Flexibility to work where you are most productive; this position is eligible to work fully remote. - Option to come into a Wellmark office if desired. - Occasional in-office meetings for specific meetings or other ‘moments that matter’ as requested by your leader.

• The Professional Fee Coder is responsible for accurately abstracting data into appropriate client electronic medical record systems • following the Official ICD-10-CM, CPT, and HCPCS Guidelines for Coding, AMA CPT Guidelines, Evaluation and Management Guidelines, and CMS directives. • Performs data entry of required abstracted patient information into the client’s information system. • Queries physicians when appropriate and interact with Clinical Documentation staff as per account requirements. • Maintains consistent coding accuracy rate of 95% or better while also meeting productivity standards. • Assigns appropriate ICD-10-CM, E/M, CPT, HCPCS codes and modifiers to professional fee accounts as per designated workflow. • Abstracts and enters coded data and/or charges for physician statistical and reporting requirements. • May assign/validate professional fee level of service based upon either 95 or 97 Evaluation and Management Guidelines. • Queries physicians to clarify conflicting, imprecise, incomplete, ambiguous, and/or inconsistent clinical information when appropriate. • Communicates documentation improvement opportunities and coding issues to appropriate personnel for follow up and resolution. • Communicates with Clinical Documentation Improvement and/or Revenue Cycle teams for follow up and reconciliation of accounts. • Maintains required productivity and quality requirements. • Maintains coding credential requirements.

Role Description The Student Coder is a temporary level coding position aimed at introducing individuals to the coding experience. Incumbents are expected to learn coding rules, guidelines, classification systems, and other relevant skills required to successfully code medical records. Responsibilities include learning and coding simple cases under direct supervision. - Growth and Development: Student coders are expected to progress through learning different types of Coding within the first three months. It is expected they will be able to understand coding rules, guidelines, and classification systems. Navigate the medical record and understand the different types of documentation needed for the service lines. - Coding Expectations: Student Coders are expected to understand coding functions within departmental guidelines. Departmental guidelines include productivity expectations, goals, accurate use of coding statuses, work queues, hard stops, and communication and relationship building with partner departments. - Coding Quality: Student Coders are expected to understand a minimum quality score of 95% in all aspects of their coding including diagnosis codes, PCS, CPT, modifiers, etc. - Shadow Experience: Student Coders will shadow other revenue cycle departments relevant to coding e.g., CDI (IP OP), Billing, Denials, Professional Coding. Student coders are expected to understand the roles of these areas and how they contribute to overall revenue cycle operations. - Presentation: Student Coders will create and present a PowerPoint presentation highlighting their experience. Qualifications - High School Diploma required. Recent graduate or currently enrolled in a Medical Coding Program strongly preferred. - No coding experience required. Past experience in healthcare related fields preferred. Clinical experience is helpful but not required. - Knowledge of medical terminology, anatomy and physiology, and disease process acquired in educational program requirements. - Good oral and written communication skills. - Ability to exercise good judgment, independent logic, light typing, and excellent computer data entry skills. - Computer system experience helpful. Company Description