Medical Coding Appeals Analyst

Sign On Bonus: $1,000

This role enables associates to work virtually full-time, except for required in-person training sessions. The position promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within commuting distance from an office.

Candidates not within reasonable commuting distance will not be considered unless accommodation is granted by law.

This position is not eligible for employment based sponsorship.

Responsibilities include:

• Reviewing medical record documentation supporting Evaluation and Management, CPT, HCPCS, and ICD-10 coding.
• Reviewing company, CMS, and competitor-specific medical and reimbursement policies, clinical research, data analysis, and legislative mandates.
• Translating medical policies into reimbursement rules.
• Performing CPT/HCPCS code and fee schedule updates, analyzing new codes for coverage, policy, reimbursement development, and system edit implications.
• Coordinating research and responding to system inquiries and appeals.
• Conducting research of claims systems and edits to identify adjudication issues and audit accuracy.
• Performing pre-adjudication claims reviews to ensure proper coding.
• Preparing correspondence to providers regarding coding and fee schedule updates.
• Training customer service staff on system issues.
• Working with provider contracting staff on reimbursement contracts.

Minimum Qualifications:

• BA/BS degree and minimum 2 years related experience or equivalent combination.
• Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) required.

Preferred Certifications:

• CEMC, RHIT, CCS, CCS-P preferred.

Elevance Health offers a range of market-competitive rewards including merit increases, paid holidays, paid time off, incentive bonuses, medical, dental, vision, disability benefits, 401(k) match, stock purchase plan, life insurance, wellness programs, and financial education resources.

The company operates a Hybrid Workforce Strategy with some on-site work expectations.

Elevance Health is an Equal Employment Opportunity employer committed to diversity and inclusion.

COVID-19 and Influenza vaccination required for certain roles. Applicants needing accommodations can contact the company for assistance.