Medical Policy & Coding Support Coordinator (CPC/CPC-A preferred) Blue Cross and Blue Shield AssociationMedical Policy & Coding Support Coordinator (CPC/CPC-A preferred)Sioux Falls, SDRemotePerform monthly medical policy coding analyses and SAP BusinessObjects reports to identify and recommend necessary changes based on comparison to BCBSA reference medical policies, sentinel commercial health plan benchmarks and utilization patterns and implementation of claim system edits to support its intent. Support Medical Policy Team's operations, including creating and managing monthly Medical Policy production timelines, quarterly production timeline for N/R/D Code processing, maintaining Medical Policy material distribution lists, and filing external appeals.
Configuration and Coding Analyst AveraConfiguration and Coding AnalystSioux Falls, South Dakota$63,960–$96,200 / yearResearch, evaluate, and implement quarterly and ongoing updates to medical coding, reimbursement methodologies, regulatory requirements, and health plan policies to ensure system configurations remain current and compliant with CMS, Medicare, Medicaid, ACA, HIPAA, NCQA, and commercial payer requirements. The position is responsible for validating claims processing and logic, maintaining coding integrity, troubleshooting configuration issues, and supporting continuous system optimization to improve automation, regulatory compliance, operational efficiency, accurate claims payment and provider coding reconsiderations.
Configuration And Coding Analyst Avera HealthConfiguration And Coding AnalystSioux Falls, SD$63,960–$96,200 / yearResearch, evaluate, and implement quarterly and ongoing updates to medical coding, reimbursement methodologies, regulatory requirements, and health plan policies to ensure system configurations remain current and compliant with CMS, Medicare, Medicaid, ACA, HIPAA, NCQA, and commercial payer requirements. The position is responsible for validating claims processing and logic, maintaining coding integrity, troubleshooting configuration issues, and supporting continuous system optimization to improve automation, regulatory compliance, operational efficiency, accurate claims payment and provider coding reconsiderations.
Configuration and Coding Analyst Avera HealthConfiguration and Coding AnalystSioux Falls, SD$63,960–$96,200 / yearResearch, evaluate, and implement quarterly and ongoing updates to medical coding, reimbursement methodologies, regulatory requirements, and health plan policies to ensure system configurations remain current and compliant with CMS, Medicare, Medicaid, ACA, HIPAA, NCQA, and commercial payer requirements. The position is responsible for validating claims processing and logic, maintaining coding integrity, troubleshooting configuration issues, and supporting continuous system optimization to improve automation, regulatory compliance, operational efficiency, accurate claims payment and provider coding reconsiderations.
Coding Audit Specialist, Health Plan Sanford HealthCoding Audit Specialist, Health PlanSDRemote$21.50–$34.50 / hourThe Coding Audit Specialist position conducts quality assurance activities to ensure the accuracy and integrity of risk adjustment data submitted to the Centers for Medicare & Medicaid Services (CMS) and Department of Health Services (DHS); identifies deficiencies and provides management with an analysis of outcomes and tools for improving accuracy in coding. Responsible for auditing medical record documentation to determine appropriate diagnostic coding for services provided, taking into account the AMA CPT coding guidelines, ICD‐9 & ICD‐10 Coding Guidelines, CMS Medicare, HHS, and DHS BadgerCare Plus risk adjustment policy and Hierarchical Condition Category Coding.
Senior Clinical Coding Analyst TriWest Healthcare AllianceSenior Clinical Coding AnalystSioux Falls, SDRemoteFull timeIndependent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources. Conducts retrospective medical claims review for coding and pricing determinations and/or coding review for inpatient (facility) claims to include diagnosis and procedural coding with DRG assignment.
Legal Records/Coding Clerk Mitchell MartinLegal Records/Coding ClerkSioux Falls, SD$5–$15 / hourBy applying for this job, you agree to receive AI-generated calls, text messages, and/or emails from Mitchell Martin Inc and its affiliates and contracted partners at various frequency through traditional and automated methods. Join our team as a Legal Records/Coding Clerk, providing essential legal support in a dynamic, onsite setting in Sioux Falls, SD.
Billing and Insurance Specialist/Medical Office Midwest Ear, Nose & ThroatBilling and Insurance Specialist/Medical OfficeSioux Falls, SDThis role will verify hearing aid benefits and prepare patient estimates and prior authorizations, establish patient payment plans within approved guidelines, and provide exceptional customer service by assisting patients and insurance carriers with billing inquiries. This position is responsible for ensuring accurate charge entry, payment posting, and account reconciliation while supporting efficient revenue cycle operations.
NewCertified Professional Coder, Special Investigations Unit (Aetna SIU) CVS Health CorpCertified Professional Coder, Special Investigations Unit (Aetna SIU)SD$43,888–$102,081 / yearThe Certified Professional Coder (CPC) will perform medical claim reviews to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.
Coder II - Outpatient AveraCoder II - OutpatientSioux Falls, South Dakota$24–$35 / hourThe Coder II focuses on determining the appropriate APC/EAPC and/or medical coding for a variety of outpatient patient types including but not limited to, ER, ancillaries, imaging, lab, PT, OT, SP and/or dialysis in the outpatient service line. What you will do Review all aspects of a patient's clinical documentation in order to identify the appropriate sequence of ICD-10-CM, CPT, and HCPCS diagnosis and procedure codes for assigned patient charts across Avera's facilities.
Coder II - Outpatient Avera HealthCoder II - OutpatientSioux Falls, SD$24–$35 / hourThe Coder II focuses on determining the appropriate APC/EAPC and/or medical coding for a variety of outpatient patient types including but not limited to, ER, ancillaries, imaging, lab, PT, OT, SP and/or dialysis in the outpatient service line. Review all aspects of a patient's clinical documentation in order to identify the appropriate sequence of ICD-10-CM, CPT, and HCPCS diagnosis and procedure codes for assigned patient charts across Avera's facilities.
Coder II - Inpatient AveraCoder II - InpatientSioux Falls, South DakotaIP Coder II is distinguished by specific services lines which could include but not limited to the following: Surgery, NICU/PICU, Cardiovascular, Women’s Health, OB, Nursery, Behavioral Health, Orthopedics, Inpatient Rehabilitation and others as appropriate. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds.
Coder II - Inpatient Avera HealthCoder II - InpatientSioux Falls, SD$25.50–$38 / hourIP Coder II is distinguished by specific services lines which could include but not limited to the following: Surgery, NICU/PICU, Cardiovascular, Women's Health, OB, Nursery, Behavioral Health, Orthopedics, Inpatient Rehabilitation and others as appropriate. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds.
ABA Clinical Reviewer TriWest Healthcare AllianceABA Clinical ReviewerSioux Falls, SDRemoteFull timeIndependent Thinking / Self-Initiative: Critical thinker with the ability to focus on things which matter most to achieving outcomes; Commitment to task to produce outcomes without direction and to find necessary resources. General knowledge of TRICARE or other government health care programs; Knowledge in the application of clinical criteria: InterQual, ICD-10-CM, DSM, and CPT coding; Proficient with Microsoft Office.
Claim Benefit Specialist CVS Health CorpClaim Benefit SpecialistSD$17–$28.46 / hourAnalyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department. Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims.
Supervisor, Utilization Management TriWest Healthcare AllianceSupervisor, Utilization ManagementSioux Falls, SDRemoteFull timeTechnical Skills: Thorough knowledge of policies and procedures, knowledge of managed care principles and methods; medical terminology; proficiency in the application of clinical criteria: InterQual, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders, current Procedural Terminology, and Healthcare Common Procedural Coding System, and American Dental codes; working knowledge with medical management systems; proficient with Microsoft Office; knowledge of UM Process; reporting techniques. • Prepares work schedules and monitors staff caseloads to ensure adequate staffing levels at all times and accurate data entry and application of the medical management system.
Revenue Integrity Analyst AveraRevenue Integrity AnalystSioux Falls, South Dakota$25.50–$38.25 / hourRequired Education, License/Certification, or Work Experience: Associate's in Healthcare Administration, Finance, Business Analytics, or related field and/or 2-3 years of experience in healthcare revenue cycle analytics, charge auditing, or payment integrity. The analyst collaborates with clinical, billing, coding, IT, and payer relations teams to identify trends, resolve discrepancies, and drive continuous improvement across Hospital Billing (HB) and Professional Billing (PB) services.
Revenue Integrity Analyst Avera HealthRevenue Integrity AnalystSioux Falls, SD$25.50–$38.25 / hourRequired Education, License/Certification, or Work Experience: Associate's in Healthcare Administration, Finance, Business Analytics, or related field and/or 2-3 years of experience in healthcare revenue cycle analytics, charge auditing, or payment integrity. The analyst collaborates with clinical, billing, coding, IT, and payer relations teams to identify trends, resolve discrepancies, and drive continuous improvement across Hospital Billing (HB) and Professional Billing (PB) services.
Certified Medical Assistant (CMA) – Regional Drug Dependency Unit Akicita FederalCertified Medical Assistant (CMA) – Regional Drug Dependency UnitSioux Falls, South DakotaThis role is responsible for assisting with patient care activities, performing routine clinical tasks, managing patient records, and supporting the overall operation of the unit, ensuring compassionate, culturally sensitive care for individuals undergoing substance abuse treatment. $50,000 - $65,000 a year Position Summary The Certified Medical Assistant (CMA) will provide clinical and administrative support to the healthcare team in the Regional Drug Dependency Unit (RDDU) at the Great Plains Area facility in Winnebago, NE.
Clinical Quality Specialist - Canton Medical Center - Full Time Sanford HealthClinical Quality Specialist - Canton Medical Center - Full TimeCanton, South DakotaGraduate from a nationally accredited nursing program preferred, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA). Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state.