Medical Appeals & Coding Specialist

University Medical Billing (UMB) is a fully remote department that serves as the premier billing office for the University of Utah School of Medicine, supporting over 1,800 providers and 30 different specialties across Utah and surrounding states. We value collaboration, innovation, and accountability, and seek a candidate who embodies these attributes.

About the role

As the Medical Appeals & Coding Specialist, you will analyze and translate medical and clinical diagnoses, procedures, injuries, or illnesses into designated numerical codes for use by physicians, hospitals, research organizations, or insurance companies. This senior-level support role involves working with medical and clinical terminology, disease processes, and pharmacology, completing assignments with minimal supervision, and assisting less-experienced team members. The position requires 3+ years of related experience and is classified as a Skilled Level position in the Support track.

Employment is contingent on a successful background check and adherence to departmental policies, including UMB's Telecommuting Agreement. This agreement requires a distraction-free, HIPAA-compliant workspace, cameras on for all virtual calls/meetings, and the ability to work during assigned office hours (Monday–Friday, approximately 8am–5pm Mountain Time), regardless of your time zone. New hires must provide their own monitors (two) and reliable internet service.

Responsibilities

• Detect abnormalities and provide recommendations for resolution.
• Review trends in work queues and provide recommendations to the supervisory team.
• Identify and summarize departmental concerns, documenting and presenting summaries and suggestions for resolution to leadership and/or departments.
• Identify, analyze, and research frequent root causes of denials, developing corrective action plans for resolution while working directly with payers.
• Provide training, presentations, and education on billing procedures and workflows in one-on-one or group settings as needed.
• Review specialty work queues for trends in quality coding and account resolution for MAC 1 & 2 team members.
• Maintain work queue expectations and monitor and resolve denials and appeals to ensure timely collection.
• Evaluate and resolve coding claim rejections and denials through the application of coding concepts, regulatory/policy review, and adherence to internal processes, including outbound communication with insurance companies.
• Compose coding appeal letters and collaborate with providers, QA Educators, and other key stakeholders.
• Communicate effectively about denial trends affecting insurance payment and escalate payers outside of turnaround times.
• Meet productivity and accuracy expectations of the position.
• Perform other duties as assigned to support team and department objectives.

Requirements

• 3+ years of related experience (1 year of higher education can substitute for 1 year of directly related work experience).
• Knowledge of medical and clinical terminology, disease processes, and pharmacology.
• Ability to independently code multi-specialties.
• Proven experience working from home effectively.
• AHIMA or AAPC Certification required.

Preferences

• High school education or equivalent.
• Minimum 3 years of coding experience or medical billing.

Pay

The starting salary for this position is $25–$28 per hour, depending on experience. Members of UMB are eligible for a bonus based on department performance.

Benefits

• 90% employer-paid medical insurance.
• Generous 14.2% retirement contribution.
• Reduced tuition.
• Paid time off (PTO) and holiday pay.

Schedule

Full-time, Monday–Friday, 8:00am–5:00pm Mountain Time.

This role is expected to work during UMB office hours, regardless of the time zone in which you reside. While UMB is a remote department, Utah-based applicants may be prioritized. At this time, the University of Utah is unable to employ individuals living in California, Colorado, New York, Oregon, or Washington.