JOB SUMMARY:

The Revenue Cycle Department team has a new opportunity available for the role of Clinical Denial Management Specialist II. The expectations for this position shall include but not be limited to the following:

• Two (2) years' follow-up / collections experience strongly preferred.
• Review, research, and resolve denials of professional claims.
• Reconcile expected payment and make necessary adjustments as required by plan reimbursement.
• Review and interpret documentation.
• Prepare and submit appeals to payers based on payor guidelines.
• Contact payers regarding reimbursement of denied claims.
• Review accuracy of payment to account
• Resolve discrepancy between insurance and billing.
• Provide feedback on denial trends to leadership.

Shift: Flex shift, start time between 0600-0900.

Work from home (WFH): This is a work from home position. Additional details shall be discussed as part of the interview process.

Quick tip(s):

• Please review the section entitled experience/education and focus on the job requirements.
• Make sure you include the experience listed under the requirements section on your application.

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 patients and employees. With over 20,000 employees, we are committed to continuing our growth with the best professionals in the healthcare industry. We invite you to be a part of the UT Southwestern team where you'll discover teamwork, professionalism, and consistent opportunities for growth.

EXPERIENCE | EDUCATION:

REQUIRED:

• High School diploma or equivalent
• And two (2) 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) preferred and may be used in lieu of experience.

JOB DUTIES:

• Review, research and resolve coding denials for E&M services, diagnostic studies, and minor 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 moderate complexity 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 or 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 moderate complex coding denials.
• Read and interpret E&M notes, diagnostic study results and or minor procedure 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.
• 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:

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.