Healthcare Policy & Appeals Coding Specialist
$38–$45/Hour | Fully Remote | Contract | Equipment Provided
We are seeking an experienced
Healthcare Policy & Appeals Coding Specialist
to support a leading national health plan on a full-time contract assignment. This is an excellent opportunity for a seasoned coding professional with strong outpatient and surgical coding expertise who enjoys resolving complex provider appeals, evaluating disputed claims, and supporting clinical coding policy development.
You will join a collaborative, three-person team responsible for maintaining clinical coding policies and claims-editing logic. The immediate priority is
payment integrity and provider appeals
, including reviewing disputed outpatient claims and medical records to determine whether claim denials should be upheld or overturned.
Contract Details
Pay:
$38–$45 per hour
Work Arrangement:
100% remote
Equipment:
Provided
Employment Type:
Contract only; minimum 2 months, with potential for extension
Schedule:
Full-time
Training:
Fixed Pacific Time hours, typically 8:00 AM–5:00 PM or 9:00 AM–6:00 PM PST
Post-Training Schedule:
Flexible core hours across U.S. time zones
Key Responsibilities
Review Provider Appeals:
Audit disputed outpatient and facility claims, review medical records, and make informed decisions to uphold or overturn denials.
Apply Coding Guidelines:
Evaluate claims against established coding rules, official guidance, and applicable industry standards.
Maintain Coding Policies:
Assist with writing, reviewing, and updating internal clinical coding policies and claims-editing logic.
Document Decisions:
Prepare clear, professional written rationales for appeal determinations, citing authoritative coding references to address provider inquiries.
Serve as a Coding Resource:
Provide subject matter expertise to internal teams, collaborating with medical directors, claims operations, and compliance.
Support Payment Integrity:
Help ensure accurate claim reimbursement and consistent application of outpatient coding guidelines.
Required Qualifications
7–10+ years of professional medical coding experience
across multiple specialties.
Extensive expertise in
outpatient and surgical coding
, particularly CPT and HCPCS.
Provider-side clinical or healthcare delivery experience, including medical record review and chart extraction.
Active certification in one of the following:
Certified Professional Coder (
CPC
)
Certified Coding Specialist (
CCS
)
Registered Health Information Administrator (
RHIA
)
Registered Health Information Technician (
RHIT
)
RHIA candidates must have extensive hands-on coding experience.
Strong analytical skills and the ability to interpret complex medical records and coding guidelines.
Excellent written communication skills, with the ability to clearly explain coding and appeal decisions.
Ability to work independently, manage a full-time workload, and collaborate effectively with a small team.
Preferred Qualifications
Previous experience with a health insurance plan, payer, or managed care organization.
Familiarity with claims platforms and editing systems such as
Facets or Optum CES
.
Experience drafting, maintaining, or revising clinical coding policies.
Background in payment integrity, provider disputes, claims auditing, or coding appeals.