Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today!

Help us lead change and transform Wellmark's business!

The health care industry is changing, and Wellmark is working to help change it for the better. We recognize that our members deserve health care with a focus on quality. We also recognize that health care is complex. We’ve embarked on a journey to support our members use and navigate the health care system in order to help them make clear, informed decisions, and we’re also ensuring that we take a team-centric approach when working with and in support of our members. The work that our diverse business and care teams are doing in collaboration with our health care partners will create these changes, all while working to minimize health care costs.

Learn more about our unique benefit offerings here.

You can also learn more about working at Wellmark here.

Use your strengths as a Payment Policy Analyst:

The Payment Policy Analyst plays a critical role in our payment integrity department. In this role you will review and scrutinize provider payment claim reports and inquiries on a daily basis for reasonableness and monitor claims trends. You will ensure claims are being paid accurately and efficiently, according to payment policies. In collaboration with an amazing team, you will work to enhance the claims payment process and contribute to the achievement of Wellmark's benefit savings goal. You will collaborate directly with the provider community, Payment Integrity partners, Medical Directors and other Wellmark stakeholders to develop and enhance provider payment policies.

Ideal candidates are naturally inquisitive and would enjoy the opportunity to develop a deep understanding of payment policies, research complex issues, and develop thoughtful solutions based on subject matter expertise. They are self-starters, detail-oriented, flexible to changing priorities, and able to succeed in a production-driven work environment. Top candidates will have claims processing and adjusting experience in Facets.

Required:

• Associate degree or equivalent work experience.
• CPC, CPC-P, COC, CCS, CCS-P, RHIT, or RHIA, or the ability to obtain a certification within 6 months of hire.
• 1+ year of experience with medical coding guidelines – e.g., CPT/HCPC or ICD10.
• Ability to work in a fast-paced environment where production goals are measured. Demonstrated commitment to timeliness, follow up, effective prioritization, organization, accuracy, and attention to detail.
• Ability to identify issues or inconsistencies, obtains relevant information, relates and compares data from different sources and identifies alternative solutions.
• Strong verbal and written communication skills with the ability to consult with stakeholders. Demonstrated ability to articulate complex information to a variety of stakeholders, both internally and externally.
• Critical thinking, problem solving, and research skills. Ability to interpret policies/procedures and apply analytical and technical knowledge in order to develop recommendations for solutions.
• Effective time management skills and the ability to organize and prioritize competing projects or tasks. Flexible and adaptable to change.
• Proficient with Microsoft Office – e.g., Outlook, Word, Excel. Technical aptitude to learn new software quickly.
• Ability to work independently and cooperatively on teams, maintaining positive relationships with customers.

Preferred:

• Associate degree.

a. Serve as a business resource in the creation, development, design, and implementation of payment policies.

b. Accountable for researching, analyzing, monitoring, and updating the resolution of complex claims, contracting and provider inquires.

c. Update coding files as required by code set revisions, HIPAA-AS, medical policy development and implementation, regulatory requirements, FEP and Blue Card guidelines, or as needed to support other internal processes.

d. Review and scrutinize provider payment claim reports on a daily basis. Review for reasonableness and monitor claims trends. Ensure claims are being paid accurately and efficiently, according to payment policies. Identify and document questionable activity and review with leader as appropriate to ensure resolution.

e. Assist and provide business expertise for system conversions and release upgrades. Provide implementation support and editing process documentation.

f. May assist in monitoring healthcare trends, industry publications and statewide regulations to provide education and potential payment policy recommendations.

g. Other duties as assigned.

Hybrid Work Environment: As a hybrid employee, you’ll spend at least three (3) days a week in the office: Tuesday, Wednesday and Thursday, with the opportunity to work remotely on Monday and Friday if desired.

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at careers@wellmark.com