Medical Appeals & Coding Specialist III

Job Summary

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.

We are looking for an experienced Medical Appeals & Coding Specialist (MAC ) III to join our team. As the Medical Appeals & Coding Specialist III , 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.

Compensation & Benefits

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. All team members are eligible for the University's comprehensive benefit package that includes 90% employer-paid medical insurance, a generous 14.2% retirement contribution, reduced tuition, PTO and holiday pay, and more!

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.

Responsibilities

Essential Functions

• Detect abnormalities and provide recommendations for resolution. 40% 

• Review trends in work queues.

• 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.

• Training & Education - 20%

• Responsible for providing 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. 

• Monitor and resolve denials and appeals to ensure timely collection. 20%

• 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- 20%

• 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. 

Minimum Qualifications

American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) recognized certification such as: Certified Professional Coder (CPC), Certified Professional Coder-Hospital (CPC-H), Certified Professional Coder-Payer (CPC-P), Certified Coding Specialist (CCS), Certified Coding Specialist - Physician Based (CCS- P), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or other specialty certification indicated by the department, AND 3 years coding, clinical, or billing experience or equivalency (one year of education can be substituted for two years of related work experience). Departments may prefer specific certifications over others.

Demonstrated knowledge of clinical documentation requirements related to regulatory and reimbursement rules and regulations, reimbursement systems (federal, state and payer specific), and health insurance processing is required. Proficiency with computer software such as Microsoft Word and Excel, and effective human relations and communication skills are also required. Some areas may require knowledge of CMS, AMA, and AHA coding and billing guidelines.

This position has no responsibility for providing care to patients.

Incumbents in this position must maintain their Continuing Education Credits (CEUs) as required by the issuing coding organization.

Preferences

An especially qualified candidate will also possess the following:

• 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

Applicants must demonstrate the potential ability to perform the essential functions of the job as outlined in the position description.

Disclaimer

This job description is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to the job.

Special Instructions

While UMB is a remote department and this role will be performed remotely, interested applicants should note the following:

• This role is expected to work during UMB office hours which are Monday through Friday, 8am to 5pm Mountain Time.

• The University of Utah is committed to providing jobs to individuals located in Utah, and sees remote roles like this as an opportunity to provide amazing employment opportunities to those living in remote areas of the state. As such, Utah-based applicants may be prioritized in the screening process.

• At this time, the University of Utah is unable to employ individuals living in California, Colorado, New York, Oregon, or Washington.

Requisition Number: PRN41434B

Full Time or Part Time? Full Time

Work Schedule Summary:

UMB Office Hours; M-F 8:00am to 5:00pm Mountain Time

Department: 00209 - Univ Medical Billing - Oper

Location: Other

Pay Rate Range: $25-$28 per hour

Close Date: 5/14/2025

Open Until Filled:

To apply, visit https://apptrkr.com/6091468

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