Job Description

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.

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