[Hiring] Clinical Denial Management Specialist III @UT Southwestern Medical Center

Role Description

The Revenue Cycle Department at UT Southwestern Medical Center has a new opportunity available for a 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 Clinical follow-up experience of complex minor and/or major surgical procedures. Preference is given to applicants with experience in:

• Surgical Oncology
• Surgical Transplant
• Oral & Maxillofacial surgery

Clinical Follow up experience using EPIC is highly preferred. CPC certification is a plus.

Work from home (WFH): This will be a 100% WFH position. Preference is given to candidates who live within fifty (50) miles of the DFW area. WFH details shall be discussed as part of the interview process.

Shift: 8-hour semi-flex shift, Monday through Friday. The shift details shall be discussed as part of the interview process.

The duties for this position will include but are not limited to the following areas of responsibility:

• Collections – Review and resolve accounts promptly per department guidelines.
• Following policies and guidelines regarding resolving invoices.
• Review documentation – to review, research coding denials for minor/major surgical procedures and any related to E&M, CPT, Diagnosis, or modifier.
• Call insurance to obtain status updates, to resolve complex denials, and regarding reimbursement discrepancies.
• Create and submit appeals for clinical and coding denials in accordance with payer guidelines, supported by appropriate documentation.
• Review accuracy of payment posted to account, reconcile discrepancies, and make necessary adjustments based on Explanation of Benefits.
• Resolve the discrepancy between insurance and billing.
• Identify and provide feedback on denial trends to leadership.
• Perform other duties as assigned by leadership.

Qualifications

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

Requirements

• Coding certifications (CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, CCS, CCA) and/or degrees (associate level, bachelor level, master level) are preferred and may be considered in lieu of experience.
• (CPC) Cert Professional Coder Upon Hire.
• (CPMA) Cert Prof Medical Auditor Upon Hire.
• (CMC) Cert Medical Coder Upon Hire.
• (ART) Assoc Records Admin Upon Hire.
• (RRA) Registered Records Admin Upon Hire.
• (RHIA) Regd Health Info Administ Upon Hire.
• (RHIT) Regd Health Info Technolo Upon Hire.
• (CCS) Cert Coding Specialist Upon Hire.
• (CCA) Cert Coding Associate Upon Hire.

Benefits

• 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.