Medical Appeals & Coding Specialist

University Medical Billing (UMB) is a fully remote department that is viewed as the premier billing office for the University of Utah School of Medicine, serving over 1,800 providers and 30 different specialties across Utah and surrounding states. We strive to be a great place to work while providing the best service to our customers. Our leaders and employees value collaboration, innovation, and accountability, and believe a successful candidate will exemplify these attributes too.

This is a Skilled Level position in the Support track. Employment is contingent on the successful completion of a background check and the adherence to departmental policies, including UMB’s Telecommuting Agreement which requires a distraction-free and HIPAA compliant workplace, cameras on for all virtual calls/meetings, and the ability to work during office hours or assigned shift (M-F, approximately 8am to 5pm Mountain Time) regardless of what time zone you live in. Additionally, new hires are required to provide their own monitors (two) and reliable internet service.

About the role

We are looking for an experienced Medical Appeals & Coding Specialist to join our team. As the Medical Appeals & Coding Specialist, you will analyze and translate medical and clinical diagnoses, procedures, injuries, or illnesses into designated numerical codes. Code records for use and planning by physicians, hospitals, research organizations, or insurance companies. Be knowledgeable of medical and clinical terminology, disease processes, and pharmacology. Complete assignments according to established guidelines and schedules. May include contact with patients, families, doctors, or insurance companies. Senior-level support role. Completes assignments with little supervision. May assist less-experienced team members. Typically requires 3+ years of related experience.

Responsibilities

• Detect abnormalities and provide recommendations for resolution.
• Review trends in work queues and provide recommendations to supervisory team.
• Identify and summarize departmental concerns.
• Determine, document and present a summary and suggestion for resolution to leadership and/or departments.
• Identifies, analyzes, and researches frequent root causes of denials and develops corrective action plans for resolution of denials working directly with the payers.
• Provide training, presentations, and education on billing procedures and workflows, one on one or in-group settings as needed.
• Reviews specialty work queues for trends for quality coding and account review and appropriate account resolution of MAC 1 & 2 team members.
• Maintain work queue expectations.
• Evaluate and resolve coding claim rejections and denials through application of coding concepts, regulatory/policy review and adherence to internal processes and outbound communication with insurance companies.
• Compose coding appeal letters and may collaborate with providers, QA Educators, and other key stakeholders.
• Collaborate with leadership team to communicate effectively about denial trends affecting insurance payment.
• Escalate payers outside of turnaround times.
• Meet productivity and accuracy expectations of the position.
• Other duties as assigned to support team and department objectives.

Requirements

• 3+ years of related experience (Medical Coder, III).
• High school education or equivalent.
• AHIMA or AAPC Certification required.
• Minimum 3 years of coding experience or medical billing.
• Ability to independently code multi-specialties.
• Proven experience working from home effectively.

EQUIVALENCY STATEMENT: 1 year of higher education can be substituted for 1 year of directly related work experience (Example: bachelor’s degree = 4 years of directly related work experience).

Benefits

• 90% employer-paid medical insurance.
• Generous 14.2% retirement contribution.
• Reduced tuition.
• PTO and holiday pay.
• Bonus based on department performance.

Pay

The starting salary for this position is $25-$28 per hour, depending on experience.

Schedule

• Full-time (40 hours per week).
• Monday through Friday, 8:00am to 5:00pm Mountain Time.