Description & RequirementsThe Senior Benefit Configuration Coding Analyst is a specialized health plan role responsible for translating complex benefit designs, regulatory requirements, and clinical intent into accurate, testable, and auditable benefit administration logic. This role operates at the intersection of benefit design, coding, configuration, compliance, and claims adjudication, ensuring benefits function exactly as intended across Commercial, Employer, and Medicare Advantage lines of business. This role serves as a key subject matter expert and liaison between Product, IHT Configuration, Provider Services, Utilization Management and Claims to support payment accuracy, reduce downstream adjustments, and strengthen overall benefit administration integrity.
WHILE THIS POSITION IS FULLY REMOTE, YOU MUST LIVE IN IDAHO, OREGON, UTAH, OR ARIZONA. What You Can Expect: - Be the expert behind the benefits. Translate complex benefit designs, clinical intent, and regulatory requirements into solutions that drive accurate, seamless member experiences.
- Apply deep technical expertise. Leverage advanced CPT, HCPCS, ICD-10-CM, revenue code, bill-type, place of service, and modifier logic across multiple lines of business.
- Shape critical business decisions. Serve as a trusted advisor on benefit interpretation, payment policy, adjudication accuracy, and compliance strategy.
- Navigate a complex regulatory landscape. Interpret and operationalize ACA preventive services, CMS Medicare Advantage rules, and state mandates, ensuring compliance and minimizing risk while identifying practical solutions.
- Solve high-impact challenges. Lead root-cause analysis, resolve complex benefit issues, and drive improvements that protect benefit integrity and financial accuracy.
- Stay ahead of risk. Conduct audits, testing, and proactive reviews to identify issues before they impact operations or members.
- Lead meaningful change. Oversee annual code updates, complex benefit implementations, and policy enhancements that influence the organization at scale.
- Make a lasting impact. Improve member experience, strengthen compliance, and help ensure every benefit works exactly as intended.
Qualifications: - Bachelors degree required or experience in lieu of degree.
- Five (5) years' relevant experience
- Must have at least one of the following credentials:
- RHIA (Registered Health Information Administrator)
- RHIT (Registered Health Information Technician)
- CCS (Certified Coding Specialist)
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder)
- CRC (Certified Risk Adjustment Coder)
What's In It For YouAt St. Luke's, caring for people in the communities we serve is our mission - and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Personify Health Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.
*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.
