Billing Specialist II - Ophthalmology

JOB SUMMARY:

UT Southwestern Medical Center is the preeminent medical facility in North Texas and one of the leading hospital systems nationwide. We have a new opening within the Department of Ophthalmology for a Billing Specialist II. The successful candidates' duties will include but not be limited to the following:

• Insurance denial follow-up
• Insurance eligibility/ verification
• Checking for referrals/authorizations
• Communicating/coordinating with other locations our providers see patients at (Parkland, CMC, JPS).
• Working insurance follow-up work queues
• unpaid claims
• Submitting corrected claims.
• Working credits for patients and insurance
• Must be able to work independently or within a group dynamic
• Familiar with EPIC, PDF

Shift: 8-hour days, flex shift Monday-Friday

Primarily work from home, estimated at 95% (may occasionally come to the office for team meetings, etc.). Cannot consider candidates who do not live in Texas. Additional details shall be discussed during the interview process.

Why UT Southwestern?

With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern Medical Center is committed to excellence, innovation, teamwork, and compassion. We invest in you with opportunities for career growth and development that align with your future goals and help to provide security for you and your family. Our highly competitive benefits package offers healthcare, PTO and paid holidays, merit increases and so much more that are all available on the day you start work.

VETERANS:

We are honored to be a veteran friendly work environment that is home to hundreds of veterans. We value your integrity, dedication, and the commitment you have made to our country. We are proud to support your next mission. Ranked by Forbes as one of the Top 10 National Employers, we invite you to be a part of the UT Southwestern Medical Center team where you will discover teamwork, professionalism, and consistent opportunities for growth. Shift: 8-hour days The preferred applicant must live in Texas, DFW area is preferred.

EXPERIENCE | EDUCATION:

• Must demonstrate the ability to work complex E&M services, diagnostic studies, and/or minor surgical procedures.
• Must demonstrate the ability to make calls to obtain authorizations.
• Coding certifications (CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, CCS, CCA) and/or degrees (associate level, bachelor level, master level) preferred and may be used in lieu of experience.

REQUIRED:

• High School diploma or equivalent
• And two (2) years medical billing or collections experience.

JOB DUTIES:

• Analyzes, investigates, and resolves coding edits for E&M services, diagnostic studies, and minor surgical procedures. This includes CPT, diagnosis, modifier, bundling, duplicate charge, and custom edit resolution. Requires knowledge of the carrier's (Federal/State/Private) regulations and guidelines, internal revenue cycle coding processes and be familiar with the billing practices of the specialty service line. This position requires a high degree of organization and accuracy and requires clear communication with providers on a regular basis to insure visits are well documented and meet all billing requirements.
• Performs limited abstracting on E&M services, diagnostic studies, and moderate to minor surgical procedures. Requires the ability to read the progress note and or procedure results and confirm or change the CPT code(s), diagnosis code(s) and modifiers (if applicable). Requires knowledge of the carrier coverage policies and be familiar with the billing practices of the specialty service line. Must be familiar with the Medicare and Medicaid teaching physician documentation billing rules.
• Performs monthly charge reconciliation. • Investigates and resolves coding and registration Epic Resolute Claim edits. Requires strong knowledge of Epic's carrier registration filing order rules and billing rules.
• Performs manual charge entry for all non-Epic Care and non-automated sites of services. This includes E&M visits and procedures across several centralized service lines. Depending on the clinical department they may be required to review and release charges from a computer assisted coding environment.
• May assist in obtaining insurance authorizations and accurately maintaining the authorization records, communicate patient balance and patient-responsibility amounts to clinics and/or patient/families, responding to requests for information. Attend coding and billing in-services to stay current on changes; attend other meetings and training as assigned.
• 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.

KNOWLEDGE, SKILLS & ABILITIES:

• Work requires working knowledge of Epic Resolute, Epic Care, and Epic CPOE.
• Work requires working knowledge of MS Excel.
• Work requires the ability to analyze problems, develop solutions, and implement new procedures.
• Work requires the ability to prioritize large volumes of work.
• Work requires good communication skills.

WORKING CONDITIONS:

Work is performed primarily in a general office/clinic area.

SECURITY:

This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.

UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.