Medical Appeals Coding Specialist
6 hours ago
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 position uses coding knowledge to abstract and record data from medical records and provides support to areas related to documentation and coding. This position analyzes codes, charges and denial trends for complex or specialty services and will serve as a resource for UMB Coding, AR, and Quality staff. This candidate employs quality assurance processes better assist department's reduction in accounts receivable and provide education to internal team members and department as appropriate. Escalating identified trends to insurance payers and/or policy issues to the appropriate resource.
Responsibilities
Conduct high-level analysis of reports; provide feedback and recommendations to aid in reduction of denials.
Quality assurance for appropriate coding and documentation, collaborate with Quality Assurance Educators and Coding supervisors on mitigation of denials related to coding and system processes.
Responsible to provide training, presentations, and education on billing and coding procedures and workflows, one on one or in-group settings as needed.
Responsible for identifying and summarizing payer concerns and escalating for resolution.
Quality Review of team for appropriate coding and documentation (review coding denial letters, review for content, and accuracy.) Provide education and collaborate with providers, QA Educators and report trends for accuracy improvement.
Assist in reviewing payer policy, procedures, workflows and updates. Working with Quality Assurance Educators, communicates to appropriate personnel and departments.
Assists with backlog to maintain department quality and productivity standards, and assists with other department needs as requested.
Manages projects as assigned.
May participate on committees and/or workgroups.
Maintain needed CEUs for coding certification.
Other duties as assigned.
Requirements
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.
Preferred Qualifications
Demonstrated knowledge of revenue cycle. Working knowledge of insurance denials, appeals and expected reimbursement rates. Experience presenting findings and educating key stakeholders. Strong written and verbal communication skills
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