Posted today
Confidential
$48,000 - $58,000
Unspecified
Remote/Hybrid• (Off-Site/Hybrid)
Piper Companies is seeking an Appeals & Coding Disputes Specialist to join a leading organization in the healthcare insurance industry for a fully remote contract position (remote in NC preferred). The Appeals & Coding Disputes Specialist will analyze and resolve appeals, grievances, and coding disputes while ensuring compliance with state, federal, and accreditation requirements.
Responsibilities of the Appeals & Coding Disputes Specialist include:
· Analyze, research, and resolve confidential appeals, grievances, and coding disputes in accordance with regulatory and accreditation guidelines.
· Interpret and explain health plan benefits, policies, medical terminology, and coding information to members and providers.
· Prepare files and develop position statements for external reviews conducted by independent review organizations and medical consultants.
· Document comprehensive investigation findings and actions across all applicable systems to support decision accuracy and timeliness.
· Monitor daily reports to ensure service-level timeliness, regulatory compliance, and workflow efficiency.
Qualifications for the Appeals & Coding Disputes Specialist include:
· Bachelor's degree or advanced degree required, or 5 years of related experience in lieu of degree.
· At least 3 years of related experience in appeals, grievances, claims, or healthcare administration.
· Ability to obtain certified professional coder (CPC) credential within one year when supporting coding disputes.
· Strong knowledge of medical terminology, coding, health plan benefits, and regulatory requirements (State, CMS, ERISA, NCQA).
· Experience partnering with clinical staff and medical directors to gather and evaluate clinical information for appeals.
Compensation for the Appeals & Coding Disputes Specialist:
· Salary Range: $48,000-$58,000/year (USD)
· Comprehensive Benefits: Medical, Dental, Vision, sick leave if required by law, and 401K
This job opens for applications on 1/28/26. Applications for this job will be accepted for at least 30 days from the posting date.
Keywords: appeals, grievances, coding disputes, medical policy, CMS, ERISA, NCQA, health insurance, coverage determinations, regulatory compliance, clinical review, healthcare administration, CPC, medical terminology, position statements, dispute resolution, claims analysis, quality assurance, documentation, investigation, member services, provider relations, healthcare operations
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Responsibilities of the Appeals & Coding Disputes Specialist include:
· Analyze, research, and resolve confidential appeals, grievances, and coding disputes in accordance with regulatory and accreditation guidelines.
· Interpret and explain health plan benefits, policies, medical terminology, and coding information to members and providers.
· Prepare files and develop position statements for external reviews conducted by independent review organizations and medical consultants.
· Document comprehensive investigation findings and actions across all applicable systems to support decision accuracy and timeliness.
· Monitor daily reports to ensure service-level timeliness, regulatory compliance, and workflow efficiency.
Qualifications for the Appeals & Coding Disputes Specialist include:
· Bachelor's degree or advanced degree required, or 5 years of related experience in lieu of degree.
· At least 3 years of related experience in appeals, grievances, claims, or healthcare administration.
· Ability to obtain certified professional coder (CPC) credential within one year when supporting coding disputes.
· Strong knowledge of medical terminology, coding, health plan benefits, and regulatory requirements (State, CMS, ERISA, NCQA).
· Experience partnering with clinical staff and medical directors to gather and evaluate clinical information for appeals.
Compensation for the Appeals & Coding Disputes Specialist:
· Salary Range: $48,000-$58,000/year (USD)
· Comprehensive Benefits: Medical, Dental, Vision, sick leave if required by law, and 401K
This job opens for applications on 1/28/26. Applications for this job will be accepted for at least 30 days from the posting date.
Keywords: appeals, grievances, coding disputes, medical policy, CMS, ERISA, NCQA, health insurance, coverage determinations, regulatory compliance, clinical review, healthcare administration, CPC, medical terminology, position statements, dispute resolution, claims analysis, quality assurance, documentation, investigation, member services, provider relations, healthcare operations
#LI-MB1 #LI-REMOTE
group id: 10430981
