Medical Claims Denial & Appeals Specialist

University of Colorado Medicine; Aurora (CO); Remote; USD 60,000 - 85,000; Full time

Job summary

University of Colorado Medicine (CU Medicine) is seeking a Medical Claims Denial & Appeals Specialist for our Accounts Receivable Resolution team. This role can be performed 100% remotely; out-of-state candidates are welcome.

The specialist resolves insurance claim denials, drafts effective appeals, and serves as a denial resolution expert for assigned divisions. Responsibilities include appeals through coding, contracts and records review; tracking denial patterns; training new staff; and

Qualifications

• 3–5 years experience in medical practice billing with denials, appeals, insurance collections and related follow-up.
• Bachelor’s degree in a related field strongly preferred.
• ICD-10 and CPT coding assessment skills; CPC certification preferred.

Responsibilities

• Appeal denials through coding review, contract review, medical record review and carrier interaction.
• Demonstrate expertise in management of complicated denied claims.
• Deploy analytical approach to resolve denials and identify trends.
• Utilize resources to ensure correct appeal processes are followed.
• Communicate denial patterns to management.
• Prioritize and process large volumes of denials with high quality.

Skills

Medical billing

Denials management

CPC certification

ICD-10/CPT coding

Communication skills

Training

Education

Bachelor's degree

Tools

MS Office

Job description

University of Colorado Medicine (CU Medicine) is the region’s largest and most comprehensive multi-specialty physician group practice. The CU Medicine team delivers business operations, revenue cycle and administrative services to support the patients of over 4,000 University of Colorado School of Medicine physicians and advanced practice providers. These providers bring their unparalleled expertise at the forefront of medicine to deliver trusted, compassionate health care services at primary and specialty care clinics as well as facilities operated by affiliate hospitals of the University of Colorado.

We are seeking a highly motivated Medical Claims Denial & Appeals Specialist to join our Accounts Receivable Resolution team.

This job can be performed 100% remotely and out of state candidates will be considered.

The Specialist is primarily responsible for resolving all insurance claim denials for assigned departments to enhance revenues for CU Medicine providers. The individual in this position will generate effective written appeals to carriers using well-researched logic. Denial Specialists are independently accountable for the denial resolution for their assigned divisions.

Duties and responsibilities include but are not limited to the following:

• Appeal denials through coding review, contract review, medical record review and carrier interaction.
• Demonstrate a high level of expertise in the management of complicated denied claims.
• Deploy analytical approach to resolve denials and recognize trends/patterns in order to proactively resolve recurring issues.
• Utilize a multitude of resources to ensure correct appeal processes are followed.
• Communicate identified denial patterns to management.
• Prioritize and process large volume of denials and maintain high quality of work.
• Serve as an escalation point for unresolved denial issues.
• Inform team members of payer policy changes.
• Assist in training new employees as assigned.
• Collaborate on special projects as needed.

Requires 3-5 years experience in medical practice billing with exposure to working with denials, appeals, insurance collections and related follow-up; bachelor’s degree in a related field is strongly preferred. Must have ICD-10 and CPT coding assessment skills, CPC certification is preferred. Intermediate PC software experience required. Advanced verbal and written communication skills are essential. Must demonstrate a solid understanding and ability to apply contract language in conjunction with a comprehensive understanding of claims denial appeal logic.

CU Medicine is an Equal Opportunity Employer and complies with all applicable federal, state, and local laws governing non-discrimination in employment. We are committed to creating a workplace where all individuals are treated with respect and dignity, and we encourage individuals from all backgrounds to apply, including protected veterans and individuals with disabilities.

CU Medicine is dedicated to ensuring a safe and secure environment for our staff and visitors. To assist in achieving that goal, we conduct background investigations for all prospective employees prior to their employment.

The listed pay range (or hiring rate) represents CU Medicine’s good faith and reasonable estimate of the range of possible compensation at the time of posting and is based on evaluation of competitive market data.

A variety of factors, including but not limited to, internal equity, experience, and education will be considered when determining the final offer.

CU Medicine provides generous leave, health plans and retirement contributions which take your total compensation beyond the number on your paycheck. Find information about our benefits here.

CU Medicine will post all jobs for a minimum of 7 days or until 250+ applicants have been received (whichever comes first).

CU Medicine supports a Tobacco Free Workplace Environment which prohibits smoking and the use of tobacco products on CU Medicine property, Anschutz Medical Campus and adjacent business locations.