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

Role Description

UT Southwestern Medical Center has a new opportunity available in the Revenue Cycle Department for the role of Clinical Denial Management Specialist III. The successful candidate will work under moderate supervision to perform advanced level billing/denial responsibilities.

• Review, research and resolve claim denials and appeals for various insurance companies while identifying payment trends to maximize collections.
• Flex shift: start between 0600-0900, 8-hour shift Monday through Friday.
• Work From Home (WFH): Candidate will work from home and can live anywhere in Texas.

Our Culture:

• The team culture is Love Based, thriving on mutual respect, empathy, and support.
• Prioritizes open communication, collaboration, and understanding.
• Creates a cohesive and inclusive community where individuals can flourish personally and professionally.
• Cultivates a culture where kindness, compassion, and appreciation are foundational principles.

Job Expectations:

• Work both independently and collaboratively within a team to achieve production goals and deadlines.
• Demonstrate a strong commitment to productivity by staying focused and on task without constant supervision.
• Effectively communicate with colleagues, supervisors, and manager to ensure clarity, alignment, and successful outcomes.
• Take ownership of assigned tasks and projects, demonstrating accountability and reliability in meeting expectations.
• Adapt to changing priorities and work demands while maintaining a high level of quality and efficiency.
• Proactively identify opportunities for process improvement and contribute innovative solutions to enhance overall productivity and teamwork.
• Ability to contact medical insurance payer and resolve outstanding claims.
• Ability to appeal denied claim and overturn the denial.

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.
• 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.

Requirements

• Experience with Reconsideration, Redetermination, and Appeal with health insurance carriers.
• Knowledge and experience with handling and resolving NCCI edits, LCD/NCD, and bundling denials.
• Knowledge and experience with denial codes from the remittance/EOB.
• Knowledge and experience with contacting health insurance carriers.
• Ability to read and understand Explanation of Benefits.
• Ability to multitask contacting insurance companies and patients.
• Knowledge and experience with online payer portals.
• Epic experience with reviewing medical records.
• Outlook experience.
• Outlook Teams App experience.
• Excel experience.
• Medical Terminology.
• Payer Portal experience.

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.