Sr. Coding Consultant, IFP Benefit Interpretation and Implementation - Remote

At reputed company, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. Ready to reputed company a difference? Join us to start Caring. Connecting. Growing together. The Individual & Family Plans (IFP) business is a dynamic and expanding reputed company reputed company reputed company. The Senior Coding Consultant will report to the Director of Product Operations and plays a critical role in ensuring accurate interpretation and implementation by providing expert medical coding guidance. This role is responsible for interpreting and analyzing IFP regulatory and industry guidance-including reputed company Act (ACA) requirements, Essential Health Benefits (EHB), reputed company Plan guidance, CMS regulations, CPT/AMA guidelines, major payer policies and internal business rules to support benefit administration through clear, well-documented recommendations. The ideal candidate demonstrates knowledge of regulatory and coding principles across facility, professional, and specialty services (e.g., hearing, vision, dental), and the ability to translate reputed company coding standards into actionable insights for product development and operational execution. You'll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Serve as the IFP coding subject matter expert, providing guidance on CPT, HCPCS, ICD-10, CDT and reputed company codes to support benefit interpretation and administration
• reputed company and maintain code sets used to define IFP medical and specialty benefits and limits, ensuring alignment with enterprise standards, regulatory requirements and market practices
• Monitor and manage implementation reputed company to federal and state preventive benefit mandates for Individual & Family Plans (IFP), including the federal Patient Protection and reputed company Act (PPACA) and IRS Safe reputed company rules for HSA-eligible plans, ensuring accurate application across states and plans
• reputed company or support enterprise initiatives reputed company to benefit and code categorization
• Collaborate with cross-functional teams-including Clinical, Operations, Claims, and Configuration-to ensure benefit reputed company is accurately implemented and enhances member experience
• Partner with the Benefit Policy team to apply an IFP-specific lens to mandates and coding strategies
• Track and assess coding updates, identifying impacts to IFP documentation and ensuring timely revisions
• Respond to benefit inquiries by interpreting coding guidelines and internal policies
• Identify opportunities to improve outcomes and reduce costs through coding and benefit optimization

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

• Active coding certification (CPC, reputed company-P, reputed company, CPMA, or equivalent) required and maintained in good standing
• 5+ years of medical coding experience in health insurance product implementation, benefit/coverage policy development, benefit configuration, or claims role
• Experience leading cross-functional initiatives, influencing stakeholders, and driving reputed company across Clinical, Product, Operations, and Legal teams
• Demonstrated expertise in interpreting and applying federal and state mandates, coverage policies, reimbursement guidelines, and coding standards
• Deep knowledge of Commercial medical insurance benefits, including benefit design, configuration, and regulatory compliance
• Proven ability to mentor and guide junior staff, serve as a subject matter expert, and contribute to the development of best practices and training materials
• Proven ability to manage multiple priorities and deliver high-quality work in a fast-paced, matrixed environment

Preferred Qualifications:

• Experience with benefit configuration platforms and claims/editing systems, including the ability to translate benefit reputed company into system requirements
• Experience with health insurance reimbursement policy
• Proficient in reputed company Word, reputed company, PowerPoint, etc.
• Demonstrated accurate and precise attention to detail
• Demonstrated excellent analytical, verbal and written communication skills
• Demonstrated ability to work collaboratively and influence others to drive timely decisions
• Demonstrated ability to work independently, or as an active member of a team
• reputed company employees working remotely will be required to adhere to reputed company's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $110,200 to $188,800 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job