Wellmark Blue Cross and Blue Shield

Analyst

• Provide clinical leadership and subject-matter expertise for complex medical policy content
• Ensure accurate implementation of medical policies and authorization requirements
• Research and analyze system and business issues
• Develop high-level requirements, test and implement solutions, and audit outcomes
• Mentor and train Coding Specialists and provide policy-related training to operational partners
• Maintain the claims processing system infrastructure to ensure compliance
• Collaborate with teams to resolve coding-related denials and questions

Health Services Coding Analyst, CPC Required

• Provide clinical leadership and subject-matter expertise to support the analysis, configuration, and administration of complex medical policy content within claims processing systems, including Plan General Exclusion (PGE) rules and FACETS table maintenance.
• Ensure the accurate implementation of medical policies, review criteria, and authorization requirements, while maintaining the integrity of system infrastructure and serving as a key liaison between business and technical teams.
• Research and analyze system and business issues, develop high-level requirements, test and implement solutions, and audit and document outcomes.
• Mentor and train Coding Specialists, and provide policy-related training and support to operational partners such as customer and provider services.