Medical Coding Appeals Specialist

Sign-On Bonus : $1,000

This position allows associates to work virtually full-time, with occasional required in-person training sessions, ensuring flexibility and a productive work-life balance. In-person onboarding and skill development will be facilitated through face-to-face interactions.

Please note that candidates must reside within a reasonable commuting distance from an office location to be considered for employment. This position is not eligible for employment-based sponsorship.

Key Responsibilities :

• Examine medical record documentation supporting Evaluation and Management, CPT, HCPCS, and ICD-10 coding.
• Analyze CMS-specific, competitor-specific, and company-specific medical and reimbursement policies, along with legislative mandates to assist in policy development and revisions.
• Translate and implement medical policies into effective reimbursement rules.
• Perform updates on CPT / HCPCS codes and fee schedules, assessing new codes for coverage and reimbursement implications.
• Coordinate research and respond to inquiries and appeals related to system issues.
• Conduct in-depth reviews of claims systems to identify and audit adjudication issues for accuracy.
• Perform pre-adjudication claim reviews to verify correct coding usage.
• Draft correspondence to providers regarding updates in coding and fee schedules.
• Provide training to customer service teams on system queries and issues.
• Collaborate with provider contracting staff for drafting new or modified reimbursement contracts.

Minimum Requirements :

Requires a BA / BS degree and a minimum of 2 years of related experience, or any combination of education and experience that provides an equivalent background. Certification as a Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) is required.

Preferred Qualifications :

About Elevance Health :

Elevance Health is committed to enhancing lives and communities, simplifying healthcare, and is recognized as a Fortune 25 company with a rich legacy in the healthcare industry. We seek passionate leaders at all levels eager to contribute positively to our members and the communities we serve.

Our Work Culture :

At Elevance Health, we strive to create a culture that not only advances organizational strategies but also fosters personal and professional growth for our associates. Our core values and behaviors drive our success and impact our consumers, associates, communities, and business outcomes.

We offer competitive total rewards including merit increases, paid holidays, Paid Time Off, incentive bonus programs, comprehensive medical, dental, and vision benefits, short- and long-term disability coverage, a 401(k) plan with matching contributions, stock purchase plans, life insurance, wellness programs, and financial education resources.

The health and safety of our associates and communities is a priority. As part of our commitment, we require candidates for certain roles to be vaccinated against COVID-19 and Influenza. Unvaccinated candidates must provide an acceptable justification to proceed with their application.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will be evaluated without regard to personal characteristics protected by law. Applicants requiring accommodation in the job application process may contact support for assistance.

All qualified applicants will be considered for employment in accordance with applicable federal, state, and local laws regarding arrest and conviction records.