Med Coding Appeals Analyst

Elevance Health

Med Coding Appeals Analyst ensuring accurate claims adjudication in a hybrid role at Elevance Health. Handling medical policies and reimbursement criteria, with required office visits.

Posted 6/10/2026full-timeIndianapolis • Ohio, Virginia • 🇺🇸 United StatesJuniorMid-LevelWebsite

About the role

Key responsibilities & impact

Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.
Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code.
Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
Translates medical policies into reimbursement rules.
Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits.
Coordinates research and responds to system inquiries and appeals.
Conducts 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.
Prepares correspondence to providers regarding coding and fee schedule updates.
Trains customer service staff on system issues.
Works with providers contracting staff when new/modified reimbursement contracts are needed.

Requirements

What you’ll need

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.
Preferred Skills, Capabilities and Experience: CEMC, RHIT, CCS, CCS-P certifications preferred.

Benefits

Comp & perks

Sign On Bonus : $1,000
medical, dental, vision, short and long term disability benefits
401(k) +match
stock purchase plan
life insurance
wellness programs
financial education resources

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

CPT codingHCPCS codingICD-10 codingdata analysisclaims adjudicationmedical policy translationreimbursement policy developmentfee schedule updatesclinical researchpre-adjudication claims review

Soft Skills

communicationtrainingcoordinationresearchproblem-solving

Certifications

Certified Professional Coder (CPC)Registered Health Information Administrator (RHIA)Certified Evaluation and Management Coder (CEMC)Registered Health Information Technician (RHIT)Certified Coding Specialist (CCS)Certified Coding Specialist - Physician-based (CCS-P)