Appeals Analyst, CPC Certified (Hybrid/Remote)

Blue Cross and Blue Shield of North Carolina; Charlotte (NC); Hybrid; USD 50,000 - 81,000; Full time

Benefits offered by this job

Annual bonus

401(k) with employer match

Paid time off

Health benefits

Job summary

Blue Cross NC seeks an Appeals Analyst to join the Coding Disputes Team in Charlotte, NC. The role focuses on analyzing and researching appeals, coding disputes and grievances, ensuring timely resolution and documentation in line with regulatory standards.

You will gather clinical information, prepare position statements for external reviews, and collaborate with Medical Directors to support clinical decisions while maintaining service quality and compliance.

Qualifications

• Bachelor’s degree or advanced degree required.
• 3 years of related experience.
• In lieu of degree, 5 years of related experience.
• For coding disputes area, certified professional coder must be obtained within 1 year of employment.
• Bonus points for CPC certification (preferred).

Responsibilities

• Analyze, research, resolve and respond to appeals, coding disputes, grievances and determinations from members, providers, and regulators.
• Explain health plan benefits, policies and coding terms to members/providers.
• Exercise judgement per BlueCross NC policies and guidelines to make appropriate decisions.
• Prepare position statements for external reviews and independent reviews when needed.
• Document investigations and actions in applicable systems and monitor daily reports for timeliness and compliance.

Education

Bachelor’s degree or advanced degree

3 years of related experience

In lieu of degree, 5 years of related experience

Certified Professional Coder (CPC) certification within 1 year

Job description

Blue Cross NC seeks an Appeals Analyst to join the Coding Disputes Team in Charlotte, NC. The role focuses on analyzing and researching appeals, coding disputes and grievances, ensuring timely resolution and documentation in line with regulatory standards.

You will gather clinical information, prepare position statements for external reviews, and collaborate with Medical Directors to support clinical decisions while maintaining service quality and compliance.