Health Plan Coding Specialist - 250844

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 ResponsibilitiesConduct 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 claimsConduct manual claim reviewsTrack outcomes and define thresholds for release of pend rulesIdentify automation and optimization opportunities within benefit coding processes.Educate and communicate coding updates to internal stakeholders as needed.Required Qualifications3+ years of direct, hands-on experience in a TPA or payer environment focused on:Health plan codingBenefit configurationClaims system setupActive 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:FacetsQNXTHealthRulesSimilar payer/TPA systemsStrong analytical skills with proven ability to:Interpret complex plan documentationTranslate benefit logic into system configurationPerform root cause analysis on claims processing errorsIdeal CandidateDetail-oriented and highly accurateAble to work independently on high-priority initiativesComfortable managing tight deadlinesExperienced navigating highly complex benefit structuresAssignment DetailsFully Remote (CT, MT, or PT time zones only)Business hours, Monday–FridayEquipment provided6–12 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.