[Hiring] Appeals Associate REMOTE USA
Position: Appeals Associate
Date posted: 2025-05-10
Industry: other
Employment type: Full Time
Experience: 3 years
Qualification: Bachelor’s Degree is required
Salary: $25–$28/hr
Location: United States, REMOTE
Company: Piper Companies
Description:
Hiring Appeals Associate – Fully Remote
United States ·
About the job
We are seeking an Appeals Associate with at least 3 years of experience in healthcare appeals, coding disputes, and grievance resolution. The ideal candidate will have a Certified Professional Coder (CPC) certification and expertise in health plan benefits, regulatory guidelines, and accreditation compliance.
Responsibilities of the Appeals Associate:
- Analyze, research, and resolve confidential/sensitive appeals, coding disputes, and grievances from members, providers, and regulatory agencies.
- Interpret and explain health plan benefits, policies, procedures, and medical terminology to stakeholders.
- Prepare files and develop position statements for external reviews by independent organizations.
- Provide comprehensive appeal and dispute responses that comply with state and federal regulatory guidelines.
- Gather clinical information using corporate medical policies, partnering with Medical Directors for appeal and grievance resolutions.
- Monitor daily reports to ensure service timeliness and compliance with NCQA, CMS, ERISA, and NCDOI accreditation standards.
- Maintain accurate documentation of investigations and findings in relevant systems.
Qualifications of the Appeals Associate:
- Bachelor’s degree or higher (or 5 years of relevant experience in lieu of a degree).
- Certified Professional Coder (CPC) required.
- Strong ability to exercise independent judgment, ensuring compliance with healthcare policies.
- Experience with external review organizations, benefit panels, and medical consultants.
- Knowledge of accreditation standards, and state/federal healthcare regulations.
Compensation of the Appeals Associate:
- Salary: $25–$28/hr, based on experience.
- Schedule: Monday–Friday, Remote.
- Benefits: Medical, Dental, Vision, 401k, and sick leave as required by law.
Application Details:
Applications for this position will be accepted for at least 30 days from the posting date.
Keywords:
Appeals associate, medical appeals, CPC, coding disputes, grievance resolution, health insurance, regulatory compliance, NCQA, CMS, ERISA, remote
