Payment Integrity Coder I

Workforce Classification:

Join Our Team: Do Meaningful Work and Improve People’s Lives 

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we are fostering a culture that emphasizes employee growth, collaborative innovation, and inspired leadership. We are dedicated to creating an environment where employees can excel and where top talent is attracted, retained, and thrives. As a testament to these efforts, Premera has been recognized on the 2025 America's Dream Employers list. Newsweek honored Premera as one of America's Greatest Workplaces, America's Greatest Workplaces for Inclusion, and America's Greatest Workplaces For Mental Well-Being, Forbes ranked Premera among America’s Best Midsize Employers for the fourth time.

Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog:  https://healthsource.premera.com/.

As a Payment Integrity Coder I, you will support the execution of Premera’s corporate wide claim payment accuracy strategy through reviewing provider appeals, performing a complete claim review, and offering provider education as part of the appeal review. You will collaborate with the payment integrity team to ensure existing programs, such as claim editing, are working correctly. This role will require coding experience, analytical skills, and solid communication and organizational adeptness.

This is a remote/telecommuter position, working from home.

What you’ll do: 

• Serve as a subject matter expert for claim payment accuracy including pre-payment claim editing, pre-payment claims auditing, contract compliance, post-payment payment integrity solutions, etc.

• Review documentation submitted with a provider appeal related to payment integrity program(s) and render a decision to uphold or overturn the denied charges.

• Perform a complete claim review while working on an appeal to ensure that all charges submitted on a claim are supported by the documentation.

• Ensure provider documentation is complete and meets industry standards. Offer improvement recommendations when appropriate.

• Coordinate with internal teams to maintain payment integrity solutions that increase claim payment accuracy.

• Participate in technology/tool updates, testing, and troubleshooting with internal teams and external vendors.

• Manage the scope of multiple inquiries, projects, or audits under minimal direct supervision.

What you’ll bring:

Required Qualifications

• Bachelor's Degree or (4) years of work experience.

• (2) years of analytical experience in a technical, healthcare, or business-related discipline, including (1) year of medical coding experience.

Preferred Qualifications

• (3) years of experience as a certified coder with a health plan, provider billing, or revenue cycle management.

• Certified Internal Auditor.

Knowledge, Skills, and Abilities

• Proven problem-solving skills - demonstrated ability to solve complex problems, which must consider long-term company-wide planning.

• Strong analytical skills - demonstrated ability to ensure reliability and relevance of data collected.

• Excellent written communication skills - demonstrated ability to compose sensitive, non-routine correspondence requiring tact and diplomacy.

Premera total rewards

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:

• Medical, vision, and dental coverage with low employee premiums.

• Voluntary benefit offerings, including pet insurance for paw parents.

• Life and disability insurance.

• Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.

• Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.

• Generous paid time off to reenergize.

• Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.

• Employee recognition program to celebrate anniversaries, team accomplishments, and more.

For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.

• Commuter perks make your trip to work less impactful on the environment and your wallet.

• Free convenient on-site parking.

• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.

• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.

• Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.

• Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.

Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin.

The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.

The salary range for this role is posted below; we generally target up to and around the midpoint of the range.

National Salary Range:

National Plus Salary Range:

*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.

We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions.