Medical Coding Appeals Analyst

Elevance Health • Lubbock, TX

106d

About The Position

This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. This position is not eligible for employment based sponsorship.

Requirements

• Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background.
• Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) certification required.

Nice To Haves

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

Responsibilities

• Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code.
• Review company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules.
• Conduct clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
• Translate medical policies into reimbursement rules.
• Perform CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits.
• Coordinate research and respond to system inquiries and appeals.
• Conduct research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy.
• Perform pre-adjudication claims reviews to ensure proper coding was used.
• Prepare correspondence to providers regarding coding and fee schedule updates.
• Train customer service staff on system issues.
• Work with providers contracting staff when new/modified reimbursement contracts are needed.

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs
• Medical benefits
• Dental benefits
• Vision benefits
• Short and long term disability benefits
• 401(k) + match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees