Billing Specialist III

UT Southwestern Medical Center • Dallas, TX

11h • Remote

About The Position

The Billing Specialist III works under moderate supervision to perform intermediate-level billing responsibilities in support of the Hematology/Oncology division. The position works from home, and applicants must live in Texas. The schedule is a flexible shift consisting of eight-hour days, Monday through Friday.

The role handles complex billing and coding work, including charge review, reconciliation, manual charge entry, and resolving coding edits and claim issues. It requires knowledge of payer regulations, revenue-cycle processes, specialty billing practices, and documentation requirements. The specialist communicates regularly with providers and may help obtain authorizations, address denials, and support clinics and patients with billing information. The role may also provide guidance, training, or mentoring to lower-level coding employees and may support multiple specialties as needed.

Requirements

• High school diploma or equivalent.
• Three years of medical billing or collections experience.
• Demonstrated ability to work complex E&M services, complex diagnostic studies, endoscopic, interventional, and/or surgical procedures.
• Demonstrated ability to make calls to obtain authorizations.
• Ability to analyze problems, develop solutions, and implement new procedures.
• Ability to prioritize large volumes of work.
• Good communication skills.
• Working knowledge of Epic Resolute, EpicCare, and Epic CPOE.
• Working knowledge of MS Excel.
• Ability to work with a team or independently.
• Strong knowledge of applicable carrier regulations and guidelines, internal revenue-cycle coding processes, and specialty-specific billing practices.
• Strong knowledge of carrier coverage policies, specialty-specific documentation requirements, and Medicare and Medicaid teaching-physician documentation billing rules.
• Strong organization and accuracy.

Nice To Haves

• Coding certifications such as CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, CCS, or CCA; certifications and/or associate-, bachelor-, or master-level degrees may be considered in lieu of experience.

Responsibilities

• Maintain a monthly average of 150 encounters per day.
• Perform charge review, reconciliation, and manual charge entry.
• Ensure the department adheres to the six-day work-queue metric.
• Analyze, investigate, and resolve coding edits for complex drug billing, diagnostic studies, endoscopic, interventional, and surgical procedures, including CPT, diagnosis, modifier, bundling, duplicate-charge, and custom edits.
• Communicate with providers to ensure services are documented and meet billing requirements.
• Resolve clinical and/or technical denials as needed.
• Abstract E&M services and complex diagnostic, endoscopic, interventional, or surgical procedures; review documentation and confirm or change applicable CPT codes, diagnosis codes, and modifiers.
• Perform monthly charge reconciliation.
• Serve as a resource to FERC Team Leads, Compliance Auditors, Medical Collectors, and Billing Specialists I and II on billing and coding issues, including denials, rejections, and backend coding edits.
• Perform manual charge entry for non-EpicCare and non-automated sites of service, including E&M visits and procedures across centralized service lines.
• Review and release charges from a computer-assisted coding environment when required by the clinical department.
• Investigate and resolve coding and registration Epic Resolute Claim edits.
• Assist with obtaining insurance authorizations and maintaining authorization records; communicate patient balances and patient-responsibility amounts to clinics and/or patients and families; and respond to requests for information.
• Attend coding and billing in-services, meetings, and training as assigned.
• May lead, train, and/or mentor lower-level designated coding employees.
• May support multiple specialties in a hybrid role as needed.
• Perform other duties as assigned.

Benefits

• PPO medical plan available on day one at no cost for full-time employee-only coverage.
• 100% coverage for preventive healthcare with no copay.
• Paid time off available on 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.
• Healthcare, paid holidays, on-site childcare, and merit increases are also mentioned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED