Clinical Denial Management Specialist III

WHY UT SOUTHWESTERN?
With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-Fort Worth according to U. S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you'll discover a culture of teamwork, professionalism, and a rewarding career!

JOB SUMMARY

The Revenue Cycle Department at UT Southwestern Medical Center has a new opportunity available for a talented Clinical Denial Management Specialist III. The successful candidate will work under moderate supervision to perform advanced level billing/denial responsibilities. The ideal applicant will have three (3) or more years of follow-up experience of complex minor and/or major surgical procedures. Preferably someone who has been a specialist in General Surgery, Bariatric and Foregut, Burn, Trauma Acute and Critical Care, Colon & Rectoral Surgery, Surgical Oncology, Surgical Transplant, Vascular Surgery, Pediatric Surgery, and Oral & Maxillofacial surgery. The duties for this position will include but not be limited to the following areas of responsibility:

• Collections - resolve denials Reconcile expected payment on fee schedule vs actual payment.
• Following policy and guidelines regarding resolving invoices
• Review documentation.
• Call insurance to resolve complex denial, obtain status.
• Create and submit appeals.
• Review accuracy of payment to account.
• Resolve discrepancy between insurance and billing.
• Provide feedback to Front End Operations.
• This will be a 100% work home position.
• Details regarding this shall be discussed as part of the interview process.

BENEFITS
UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100% coverage for preventive healthcare-no copay
• Paid Time Off, available day one
• Retirement Programs through the Teacher Retirement System of Texas (TRS)
• Paid Parental Leave Benefit
• Wellness programs
• Tuition Reimbursement
• Public Service Loan Forgiveness (PSLF) Qualified Employer
• Learn more about these and other UTSW employee benefits!

EXPERIENCE AND EDUCATIONRequired

• Education
  High School Diploma Or equivalent or

• Experience
  2 years Medical billing or collections experience. and
  Must demonstrate the ability to work clinical denials for complex E&M services, diagnostic studies, and/or minor surgical procedures and
  Must demonstrate a strong knowledge of medical claims recovery and/or collections rules and regulations

Preferred

• Education
  Associate's Degree May be used in lieu of experience. or
  Bachelor's Degree May be used in lieu of experience. or
  Master's Degree May be used in lieu of experience.

• Licenses and Certifications
  (CPC) CERT PROFESSIONAL CODER or
  (CPMA) Cert Prof Medical Auditor or
  (CMC) CERT MEDICAL CODER or
  (ART) ASSOC RECORDS ADMIN or
  (RRA) REGISTERED RECORDS ADMIN or
  (RHIA) REGD HEALTH INFO ADMINIST or
  (RHIT) REGD HEALTH INFO TECHNOLO or
  (CCS) CERT CODING SPECIALIST or
  (CCA) Cert Coding Associate

JOB DUTIES

• Review, research and resolve coding denials for complex diagnostic studies, endoscopic, interventional and/or major surgical procedures. This includes denials related to the billed E&M, CPT, diagnosis, and modifier. Denial types could include bundling, concurrent care, frequency and limited coverage. Prepare and submit claim appeals, based on payor guidelines, on complex coding denials. Identify denial, payment, and coding trends in an effort to decrease denials and maximize collections.
• Contact payers, via website, phone and/or correspondence, regarding reimbursement of claims denied for coding related reasons. Interpret Managed Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection.
• Requires knowledge of carrier specific claim appeal guidelines. This includes Claim Logic, internet, and paper/fax processes. Requires proven analytical, and decision making skills to determine what selective clinical information must be submitted to properly appeal the denial. Requires proven knowledge of CPT and ICD-10 coverage policies, internal revenue cycle coding processes and the billing practices of the specialty service line. This position requires clear and concise written and oral communication with payors, providers, and billing staff to insure resolution of complex coding denials.
• Requires the ability to read and interpret E&M notes, complex diagnostic study results, endoscopic and interventional results and/or major surgical operative notes. Based on the documentation review, confirm or change the billed CPT code(s), diagnosis code(s) and modifiers (if applicable) in order to attain denial resolution. Requires proven knowledge of the specialty specific service line documentation requirements. Must be familiar with the Medicare and Medicaid teaching physician documentation billing rules within 60 days of hire.
• Serves as a resource to the FERC Team Leads, Compliance Auditors, Medical Collectors and MSRDP Clinical Denials Management Specialist I & II. Requires a billing and coding knowledge level that provides guidance on and resolution to resolve claim denials and rejections.
• Makes necessary adjustments as required by plan reimbursement.
• Duties performed may include one or more of the following core functions: (a) Directly interacting with or caring for patients; (b) Directly interacting with or caring for human-subjects research participants; (c) Regularly maintaining, modifying, releasing or similarly affecting patient records (including patient financial records); or (d) Regularly maintaining, modifying, releasing or similarly affecting human-subjects research records.
• Performs other duties as assigned.

SECURITY AND EEO STATEMENTSecurity
This position is security-sensitive and subject to Texas Education Code 51. 215, which authorizes UT Southwestern to obtain criminal history record information.

EEO Statement
UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all mem.