Clinical Policy Coding Administrator

Premera Blue Cross is a health insurance organization dedicated to improving customers’ lives by making healthcare work better through innovation, collaboration, and member-focused solutions. This role serves as a senior member of the Medical Policy and Clinical Coding team, focusing on clinical coding accuracy, medical policy implementation, and claims configuration to ensure appropriate payment, compliance, and effective healthcare cost management.

Premera is seeking a Clinical Policy Coding Administrator to join its Medical Policy and Clinical Coding team. This senior-level role is critical to ensuring accurate claims processing, appropriate reimbursement, and effective healthcare cost management. The position bridges clinical expertise and operational configuration, aligning medical policies with correct coding and claims system edits to support safe services and precise payment outcomes.

Responsibilities:
- Collect and analyze data to evaluate medical policy implementation effectiveness and update appropriate procedure and diagnosis codes  
- Support medical policy development by identifying coding that reflects medical necessity and utilization management guidelines  
- Serve as a subject matter expert for cross-functional teams on coding edit decision-making  
- Conduct analysis and research to ensure accuracy in claims processing and reimbursement configuration  
- Develop tools to analyze patterns of code payments, denials, and policy changes  
- Contribute to provider appeal analysis including coding assessments and CCI edit reviews  

Requirements:
- Bachelor’s degree or four years of relevant work experience  
- Current Certified Professional Coder (CPC) certification  
- Four years of clinical coding experience, including two years in a health plan or healthcare setting  
- Previous payer or health plan experience  
- Strong knowledge of ICD coding systems, billing, claims processing, and medical terminology  
- Strong analytical skills and ability to influence cross-functional stakeholders  

Benefits:
- Comprehensive medical, dental, and vision coverage  
- 401(k) with employer match and pension plan  
- Tuition assistance and wellness programs  
- Generous paid time off  

Join Premera to help improve healthcare delivery through expert clinical coding and policy alignment.