CPC Certified Appeals Associate

Job Summary

A company is looking for an Appeals Associate with experience in healthcare appeals and coding disputes.

Key Responsibilities

• Analyze, research, and resolve confidential appeals, coding disputes, and grievances
• Interpret and explain health plan benefits, policies, and medical terminology to stakeholders
• Prepare files and develop position statements for external reviews by independent organizations

Required Qualifications

• Bachelor's degree or 5 years of relevant experience in lieu of a degree
• Certified Professional Coder (CPC) certification required
• Experience with external review organizations, benefit panels, and medical consultants
• Knowledge of accreditation standards and state/federal healthcare regulations
• Strong ability to exercise independent judgment in compliance with healthcare policies