Remote Benefit Plan Coding & Reimbursement Policy Analyst (RN, Payer-Side)
Do you want to work for a company that Forbes named one of the Top 50 Most Innovative Companies? Are you looking to fast-track your career with one of LinkedIn's top companies in the U.S.? If so, keep reading! CSI Companies is hiring a Remote Benefit Plan Coding & Reimbursement Policy Analyst (RN, Payer-Side) for our Fortune100 healthcare client. Location: Remote
Pay: $45-65/hr. based on experience, certifications, and education
Hours: Full time hours, Monday to Friday, 9am - 5pm EST Status: Long-term Consultant: Starting off as a consultant/contractor there is always potential for long term / conversion for the right employee upon business needs. Almost all of the positions within this client start off as a contractor due to being a Fortune 100 company. Job Summary
We are seeking an experienced Benefit Plan Coding & Reimbursement Policy Analyst to support a full-time COC/SPD initiative focused on building and validating coding logic for health plan benefit designs. This role is not clinical documentation or risk adjustment coding. Instead, it requires deep expertise in payer-side benefit interpretation, reimbursement policy coding, and mapping CPT/HCPCS codes to Summary Plan Descriptions (SPDs), Certificates of Coverage (COCs), and reimbursement methodologies. The ideal candidate understands how health plans adjudicate claims and how benefit language translates into operational coding logic within managed care systems. Why this Opportunity?
• Top ranked company in Fortune's 2024 "World's Most Admired Companies" for over a decade consecutively.
• This healthcare client is ranked number one in key attributes of reputation:
• Innovation
• People management
• Social responsibility
• Quality of Management
• Financial soundness
• Long-term investment value
• Quality of products
• Services and global competitiveness.
What You'll Do:
• Determine which CPT/HCPCS/ICD-10 codes align with specific benefit plan language within SPDs and COCs
• Translate coverage language into structured coding documents and reimbursement matrices
• Review peer coding designations and reconcile discrepancies
• Facilitate discussions to finalize benefit coding documents and adjudication logic
• Review coding audit results and adjust documentation as needed
• Support benefit configuration validation and claims logic alignment
• Interpret reimbursement methodologies (APC, RBRVS, ASC fee schedules, etc.)
• Participate in project meetings and cross-functional collaboration sessions
Who You Are:
• Active unrestricted RN license (required)
• AAPC or AHIMA coding certification (CPC, CCS, etc.) required
• 3+ years of experience with CPT, HCPCS, ICD-10, CMS reimbursement methodologies
• 3+ years of payer-side coding or reimbursement policy experience
• Demonstrated experience with:
• SPD/COC review
• Benefit plan coding
• Coverage policy interpretation
• Code-to-benefit mapping
• Reimbursement policy analysis
• Strong understanding of how health plans adjudicate claims
• Experience with managed care or payer operations
Highly Preferred:
• Experience building coding crosswalks or reimbursement matrices
• Experience supporting claims system configuration (Facets, QNXT, HealthRules, etc.)
• Peer coding review or coding audit experience
• Proficiency in Microsoft Word, Excel, Access, and PowerPoint
• Strong written and verbal communication skills
• Prior managed care experience strongly preferred
WHO SHOULD APPLY?
This role is ideal for RN coders working in managed care, reimbursement policy, or benefit configuration who understand how CPT/HCPCS codes map to plan language and adjudication logic. Candidates with payer-side benefit coding, medical policy coding, or reimbursement analysis experience will thrive in this environment. This role is not suited for provider-side coders, HCC/risk adjustment specialists, CDI professionals, or encounter-level medical record coders without direct benefit interpretation and reimbursement policy experience. About Us
CSI Companies is a recruiting firm established in 1994 that has been awarded "Best of Staffing" for over a decade. We provide outstanding services to the world's leaders in the healthcare field as well as other organizations. For consideration, please submit your resume with all of your relevant experience included on it for immediate consideration. Only those candidates identified for an interview will be contacted. Benefits Offered:
• Weekly pay
• Medical, dental, and vision coverage
• Voluntary Life and AD&D coverage
• Paid Training
• Opportunity for advancement upon performance and availability
APPLY NOW and a recruiter will be in touch to schedule a phone interview! #VMSUL
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Pay: $45-65/hr. based on experience, certifications, and education
Hours: Full time hours, Monday to Friday, 9am - 5pm EST Status: Long-term Consultant: Starting off as a consultant/contractor there is always potential for long term / conversion for the right employee upon business needs. Almost all of the positions within this client start off as a contractor due to being a Fortune 100 company. Job Summary
We are seeking an experienced Benefit Plan Coding & Reimbursement Policy Analyst to support a full-time COC/SPD initiative focused on building and validating coding logic for health plan benefit designs. This role is not clinical documentation or risk adjustment coding. Instead, it requires deep expertise in payer-side benefit interpretation, reimbursement policy coding, and mapping CPT/HCPCS codes to Summary Plan Descriptions (SPDs), Certificates of Coverage (COCs), and reimbursement methodologies. The ideal candidate understands how health plans adjudicate claims and how benefit language translates into operational coding logic within managed care systems. Why this Opportunity?
• Top ranked company in Fortune's 2024 "World's Most Admired Companies" for over a decade consecutively.
• This healthcare client is ranked number one in key attributes of reputation:
• Innovation
• People management
• Social responsibility
• Quality of Management
• Financial soundness
• Long-term investment value
• Quality of products
• Services and global competitiveness.
What You'll Do:
• Determine which CPT/HCPCS/ICD-10 codes align with specific benefit plan language within SPDs and COCs
• Translate coverage language into structured coding documents and reimbursement matrices
• Review peer coding designations and reconcile discrepancies
• Facilitate discussions to finalize benefit coding documents and adjudication logic
• Review coding audit results and adjust documentation as needed
• Support benefit configuration validation and claims logic alignment
• Interpret reimbursement methodologies (APC, RBRVS, ASC fee schedules, etc.)
• Participate in project meetings and cross-functional collaboration sessions
Who You Are:
• Active unrestricted RN license (required)
• AAPC or AHIMA coding certification (CPC, CCS, etc.) required
• 3+ years of experience with CPT, HCPCS, ICD-10, CMS reimbursement methodologies
• 3+ years of payer-side coding or reimbursement policy experience
• Demonstrated experience with:
• SPD/COC review
• Benefit plan coding
• Coverage policy interpretation
• Code-to-benefit mapping
• Reimbursement policy analysis
• Strong understanding of how health plans adjudicate claims
• Experience with managed care or payer operations
Highly Preferred:
• Experience building coding crosswalks or reimbursement matrices
• Experience supporting claims system configuration (Facets, QNXT, HealthRules, etc.)
• Peer coding review or coding audit experience
• Proficiency in Microsoft Word, Excel, Access, and PowerPoint
• Strong written and verbal communication skills
• Prior managed care experience strongly preferred
WHO SHOULD APPLY?
This role is ideal for RN coders working in managed care, reimbursement policy, or benefit configuration who understand how CPT/HCPCS codes map to plan language and adjudication logic. Candidates with payer-side benefit coding, medical policy coding, or reimbursement analysis experience will thrive in this environment. This role is not suited for provider-side coders, HCC/risk adjustment specialists, CDI professionals, or encounter-level medical record coders without direct benefit interpretation and reimbursement policy experience. About Us
CSI Companies is a recruiting firm established in 1994 that has been awarded "Best of Staffing" for over a decade. We provide outstanding services to the world's leaders in the healthcare field as well as other organizations. For consideration, please submit your resume with all of your relevant experience included on it for immediate consideration. Only those candidates identified for an interview will be contacted. Benefits Offered:
• Weekly pay
• Medical, dental, and vision coverage
• Voluntary Life and AD&D coverage
• Paid Training
• Opportunity for advancement upon performance and availability
APPLY NOW and a recruiter will be in touch to schedule a phone interview! #VMSUL
Apply tot his job
Apply To this Job