Health Plan Coding Contractor (Dental/Vision)
Fully Remote (Ideally reside in Central, Mountain, or Pacific Time Zones)
Contract: 6–12 months (Potential Contract-to-Hire)
We are seeking an experienced
Health Plan Coding Contractor
to serve as a subject matter expert (SME) supporting complex benefit configurations and strategic client implementations within a payer/TPA environment.
This is a high-impact role ideal for someone who thrives in complex claims systems, understands nuanced benefit structures, and brings strong dental/vision coding expertise.
Key Responsibilities Conduct comprehensive review and validation of health plan coding for accuracy, regulatory compliance (e.g., ERISA, ACA), and alignment with client-specific benefit designs. Translate complex Summary Plan Descriptions (SPDs) and Evidence of Coverage (EOCs) into compliant coding configurations within enterprise benefit platforms. Directly participate in coding within the claim adjudication system. Perform proactive and scheduled audits of coded benefits across platforms. Provide coding expertise to resolve complex or edge-case claim processing issues. Lead cross-functional collaboration with MCA teams to: Create pend rules for impacted claims Conduct manual claim reviews Track outcomes and define thresholds for release of pend rules Identify automation and optimization opportunities within benefit coding processes. Educate and communicate coding updates to internal stakeholders as needed.
Required Qualifications 3+ years of direct, hands-on experience in a TPA or payer environment focused on: Health plan coding Benefit configuration Claims system setup Active coding credential from a recognized organization (e.g., AAPC, AHIMA) 1+ year of dental and/or vision insurance coding experience (required) Experience working within enterprise platforms such as: Facets QNXT HealthRules Similar payer/TPA systems Strong analytical skills with proven ability to: Interpret complex plan documentation Translate benefit logic into system configuration Perform root cause analysis on claims processing errors
Ideal Candidate Detail-oriented and highly accurate Able to work independently on high-priority initiatives Comfortable managing tight deadlines Experienced navigating highly complex benefit structures
Assignment Details Fully Remote (CT, MT, or PT time zones only) Business hours, Monday–Friday Equipment provided 6–12 month contract (possible conversion to FTE based on business need)
Note: If converted to FTE, candidate must be local to Lehi, UT and available onsite Tuesdays/Wednesdays.
If you’re a seasoned payer-side coding professional with dental/vision expertise and enjoy solving complex benefit challenges, we’d love to connect.
We are seeking an experienced
Health Plan Coding Contractor
to serve as a subject matter expert (SME) supporting complex benefit configurations and strategic client implementations within a payer/TPA environment.
This is a high-impact role ideal for someone who thrives in complex claims systems, understands nuanced benefit structures, and brings strong dental/vision coding expertise.
Key Responsibilities Conduct comprehensive review and validation of health plan coding for accuracy, regulatory compliance (e.g., ERISA, ACA), and alignment with client-specific benefit designs. Translate complex Summary Plan Descriptions (SPDs) and Evidence of Coverage (EOCs) into compliant coding configurations within enterprise benefit platforms. Directly participate in coding within the claim adjudication system. Perform proactive and scheduled audits of coded benefits across platforms. Provide coding expertise to resolve complex or edge-case claim processing issues. Lead cross-functional collaboration with MCA teams to: Create pend rules for impacted claims Conduct manual claim reviews Track outcomes and define thresholds for release of pend rules Identify automation and optimization opportunities within benefit coding processes. Educate and communicate coding updates to internal stakeholders as needed.
Required Qualifications 3+ years of direct, hands-on experience in a TPA or payer environment focused on: Health plan coding Benefit configuration Claims system setup Active coding credential from a recognized organization (e.g., AAPC, AHIMA) 1+ year of dental and/or vision insurance coding experience (required) Experience working within enterprise platforms such as: Facets QNXT HealthRules Similar payer/TPA systems Strong analytical skills with proven ability to: Interpret complex plan documentation Translate benefit logic into system configuration Perform root cause analysis on claims processing errors
Ideal Candidate Detail-oriented and highly accurate Able to work independently on high-priority initiatives Comfortable managing tight deadlines Experienced navigating highly complex benefit structures
Assignment Details Fully Remote (CT, MT, or PT time zones only) Business hours, Monday–Friday Equipment provided 6–12 month contract (possible conversion to FTE based on business need)
Note: If converted to FTE, candidate must be local to Lehi, UT and available onsite Tuesdays/Wednesdays.
If you’re a seasoned payer-side coding professional with dental/vision expertise and enjoy solving complex benefit challenges, we’d love to connect.