CPC-Certified Appeals Analyst — Hybrid/Remote

Blue Cross and Blue Shield of North Carolina; United States; Hybrid; USD 50,000 - 81,000; Full time

Job summary

Blue Cross and Blue Shield of North Carolina is seeking an Appeals Analyst to join the Coding Disputes Team. The role involves analysis and research to process appeals, coding disputes, and grievances, ensuring timely, accurate documentation and compliance with regulatory standards and organizational policies.

The position requires a bachelor’s degree and 3 years of related experience; CPC certification within 1 year is preferred.

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, CPC certification must be obtained within 1 year of employment.

Responsibilities

• Analyze, research, resolve and respond to appeals, coding disputes, grievances and determinations.
• Explain health plan benefits, procedures, and coding to members/providers.
• Prepare position statements for external reviews and independent reviews.
• Provide comprehensive responses that meet regulatory guidelines.
• Document investigations and actions in all applicable systems.
• Monitor daily reports to ensure timeliness and compliance.

Skills

Experience requirement

Regulatory understanding

Education

Bachelor’s degree or higher

Job description

Blue Cross and Blue Shield of North Carolina is seeking an Appeals Analyst to join the Coding Disputes Team. The role involves analysis and research to process appeals, coding disputes, and grievances, ensuring timely, accurate documentation and compliance with regulatory standards and organizational policies.

The position requires a bachelor’s degree and 3 years of related experience; CPC certification within 1 year is preferred.