Sr Config Coding Analyst - St. Luke's Health Plan

Description & Requirements

The Sr 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.

• Leads translation of complex benefit designs, clinical intent, and regulatory requirements into executable benefit administration logic.
• Serves as senior subject matter expert for benefit interpretation, coding application, and adjudication accuracy.
• Authors and maintains benefit interpretation guidance, payment policies, and operational procedures.
• Applies advanced CPT, HCPCS, ICD-10-CM, revenue code, bill-type, place of service and modifier logic across all lines of business.
• Independently interprets and operationalizes ACA preventive services, CMS Medicare Advantage rules, and state mandates, identifying compliance risk and recommending benefit-related operational solutions.
• Performs proactive benefit audits, testing, and risk identification prior to production release.
• Leads root‑cause analysis and resolution of high‑risk or high‑impact benefit issues.
• Oversees annual code updates and complex benefit change logic.
• Exercises independent judgment to protect benefit integrity, financial accuracy, and compliance, providing formal recommendations to leadership on benefit interpretation and payment policy.
• Elevates benefit integrity, member experience, and compliance through independent judgment and deep technical expertise.
• Performs other duties and responsibilities as assigned.
• Education:
  
  Bachelors degree required or experience in lieu of degree.
• Experience:
  
  5 years experience.
• Licenses/Certifications:
  
  Must have at least one of the following credentials: RHIA, RHIT, CCS, CPC, COC, CIC, CRC.

e’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.

St. Luke’s is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.

• Please note:
  
  this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.