Job Summary
This position focuses on the research, development, upkeep, and documentation of payment policies. The role involves analyzing claims, responding to provider inquiries, reviewing medical records, and identifying trends to address payment-related challenges and propose solutions.
Responsibilities
- Research and develop effective payment policies.
- Maintain and document policies while ensuring compliance.
- Review claims, provider inquiries, and medical records.
- Analyze trends to identify and resolve payment issues.
- Collaborate with internal teams, healthcare providers, and vendors.
- Enhance claims accuracy through systematic improvements.
- Update coding files and support necessary system changes.
Qualifications
- Associate degree or equivalent work experience required.
- Active and unrestricted Iowa or South Dakota LPN or RN license.
- Coding certification or the capability to obtain one within six months.
- Diverse clinical experience is essential.
- Strong analytical and communication skills are necessary.
- Knowledge of regulatory standards in healthcare is required.
- Proficiency in Microsoft Office applications is expected.
- Ability to prioritize tasks and collaborate effectively with various stakeholders.
Wellmark, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
