North Carolina Licensed Appeals Associate

Job Summary

A company is looking for an Appeals Associate for a remote contract position.

Key Responsibilities

• Analyze, research, and resolve appeals, coding disputes, and grievances from members, providers, and regulatory agencies
• 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 higher (or 5 years of relevant experience in lieu of a degree)
• Certified Professional Coder (CPC) required
• Experience with external review organizations and medical consultants
• Knowledge of accreditation standards and state/federal healthcare regulations
• Strong ability to exercise independent judgment in compliance with healthcare policies