Teams at WellSky

Review and adjudicate member and provider appeals (including Medicare QIO and expedited appeals), classify cases, ensure regulatory and contractual compliance, prepare and submit appeal packages within turnaround times, apply clinical guidelines, and participate in team calibration and quality activities.

Serve as primary client contact for medical coders: provide training, conduct coding reviews and audits, give coding compliance feedback, escalate issues, and collaborate with internal teams to improve coding quality and client satisfaction.

Design, build, and maintain scalable data pipelines, data models, ETL/ELT, and BI solutions. Collaborate with data scientists and stakeholders to improve data quality, accessibility, and PHI security. Develop and document workflows, optimize processing/storage, support data warehouse and visualization, and adopt AI tools to drive data-informed outcomes.