Work from home (WFH): This is a WFH position. However, applicants must live in the state of Texas. Additional details related to WFH shall be discussed during the interview process

Shift: Either 7:00am-3:30 or 8:00am-4:30pm

JOB SUMMARY:

UT Southwestern Medical Center has a new employment opportunity available in the Patient Financial Services Department for a Research Billing Specialist. This team is moderate in size but huge on passion and possess an all hands on deck climate of teamwork. The applicant's duties and responsibilities shall include but not be limited to the following:

• Works under moderate supervision to analyze and resolve complex clinical research patient accounts
• Responsible for establishing, updating, and implementing procedures regarding the billing of clinical research activities
• EPIC hyperdrive experience strongly preferred
• Previous high-volume billing
• Ability to work alone or with a team dynamic
• Team player
• Excellent time management
• Attention to detail

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
• Associates degree preferred
• And three (3) years medical billing or collections experience
• Billing for research and clinical trial services preferred
• Experience involving complex diagnostic studies, endoscopic, interventional and/or surgical procedures preferred
• Working knowledge of Velos (or other research/clinical trials management system), Epic Resolute, and Epic-Care preferred. Certified Professional Coder (CPC), Advanced Records Technician (ART), or Registered Records Administrator (RRA) preferred. Coding certifications (CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, CCS, CCA) and/or degrees (associate level, bachelor level, master level) may be considered in lieu of experience.

JOB DUTIES:

• Reviews professional charges daily that are in the Epic charge router review work queues, charge review work queues, Epic generated reports and or Microsoft Excel files and segregates them as standard-of-care services, research-related services, or indeterminate services. Standard-of-care ensure the service(s) are moved to the patient's Epic personal/family guarantor account. Research-related ensure the service(s) are moved to the research guarantor account.
• For charges that are identified as indeterminate, this position utilizes the Velos system, UTSW, CMC, or PHHS Epic systems ("Patients needing research billing review report") and clinical orders. Works with research study coordinators, research compliance coordinators, research principle investigators, transplant billing coordinators, the UTSW clinical research services office, and or the sponsored programs administration to determine if the service(s) are standard-of-care or research-related.
• Responsible for identifying workflow issues, developing suggestions for improvement, and providing in-services to other areas regarding the clinical research billing processes.
• Responsible for ensuring that all charges related to clinical research activities are billed appropriately to either insurance(s) or the clinical research sponsor for each patient treated under each clinical research study in conjunction with the various services being charged for hospital services.
• Monitors the routing of charges to ensure the routing rules are working correctly and the work queues are receiving charges appropriately. Works with UTSW HSIR to modify and test changes to the charge routing rules when appropriate.
• Identifies and resolves edits in the systems which may be delaying the billing process. Ensures subsequent follow up activity is established and adheres to a timely schedule to follow up on accounts.
• Manages the clinical research accounts to be processed, looking for ways to continually improve the process resulting in charges being billed to either clinical research sponsors or health insurance.
• Demonstrates a thorough knowledge and understanding of each phase of the process and a familiarity with all systems involved. This includes a complete understanding of clinical research procedures and third-party billing requirements in order to effectively carry out assigned duties.
• Determines appropriate reimbursement methodology and applies to clinical research accounts according to established clinical research study.
• Follows each account to final resolution by identifying it as a write-off, re-bill or appeal and refers to the appropriate party to complete the process in a timely manner.
• Acts as a resource for access and billing staff throughout the department on matters of clinical research billing.
• Keeps abreast of changing regulations and follows established rules and guidelines by working closely with various departments throughout UT Southwestern Medical Center.
• May provide coding education to providers and others, as appropriate and be prepared to present clinical encounters for review and discussion.
• Attends training classes, as determined by management.

KNOWLEDGE, SKILLS & ABILITIES:

• Work requires working knowledge of Epic Resolute, Epic Care, and Epic CPOE.
• Work requires working knowledge of MS Excel.
• Work requires ability to analyze problems, develop solutions, and clearly communicate recommendations to supervisor.
• Work requires the ability to prioritize and manage large volumes of work.
• Work requires strong knowledge of Federal/State/Private payor general coverage principles, clinical trial policies, research and clinical trials investigating medical device policies, billing regulations and guidelines, and especially the Medicare July 2007 NDC Routine Costs in Clinical Trials (310.1) document.
• Work requires a working history with the Clinical Research Management System (CRMS) called Velos eResearch system and applying the documented coverage analysis to billed professional clinical services.
• Requires a working knowledge of how to apply routine and investigational clinical services modifiers and diagnosis coding.
• Work requires a high degree of organization and accuracy, and clear communication with all research and clinical trial stakeholders.
• Work requires excellent communication skills, both verbally and in writing, in a clear and concise professional manner.
• Work requires meeting department accuracy and production standards.
• Work requires flexibility to adapt to changing work assignments.
• Work requires the ability to work independently without close supervision.
• Work requires ability to demonstrate good teamwork skills.

WORKING CONDITIONS:

Work is performed primarily remotely. There may be times, however, where working in the office is required.

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.