Med Coding Appeals Analyst

Sign On Bonus: $1,000

This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy, supporting productivity and work-life integration. 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 an accommodation is granted by law.

This position is not eligible for employment-based sponsorship.

Responsibilities include ensuring accurate adjudication of claims by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.

Primary duties:

• Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 coding.
• Review company-specific, CMS-specific, and competitor-specific medical policies, reimbursement policies, editing rules; conduct clinical research, data analysis, and identify legislative mandates for drafting and/or revising enterprise reimbursement policy.
• Translate medical policies into reimbursement rules.
• Perform CPT/HCPCS code and fee schedule updates; analyze new codes for coverage, policy, reimbursement development, and system edit implications.
• Coordinate research and respond to system inquiries and appeals.
• Research claims systems and system edits to identify adjudication issues and audit claims adjudication accuracy.
• Perform pre-adjudication claims reviews to ensure proper coding use.
• Prepare correspondence to providers regarding coding and fee schedule updates.
• Train customer service staff on system issues.
• Collaborate with provider contracting staff on new or modified reimbursement contracts.

Minimum requirements:

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

Preferred skills and certifications:

• CEMC, RHIT, CCS, CCS-P certifications preferred.

Elevance Health is a Fortune 25 health company dedicated to improving lives and communities by making healthcare simpler. They offer comprehensive benefits including merit increases, paid holidays, Paid Time Off, incentive bonuses, medical, dental, vision, disability benefits, 401(k) with match, stock purchase plan, life insurance, wellness programs, and financial education.

The company operates under a hybrid workforce strategy requiring at least weekly onsite presence unless specified otherwise.

Elevance Health is an Equal Employment Opportunity employer and complies with all applicable laws regarding non-discrimination and accommodations.