Medical Appeal & Coding Specialist

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. 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. This is a Skilled Level position in the Support track.

The starting salary for this position is $25-$28/hr , 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

Responsibilities:

• Detect abnormalities and provide recommendations for resolution.
• 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.
• 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.
• 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.
• 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.

This job description has been designed to indicate the general nature and level of work performed by employees within this classification. It’s not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to the job.

Minimum Qualifications

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).

Medical Coder, III : Requires 3+ years of related experience.

Preferences

Preferred Qualifications

• 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