Clinical Denial Management Specialist I

UT Southwestern Medical Center • Dallas, TX

15h • Remote

About The Position

The Revenue Cycle Department team has a new opportunity available for the role of Clinical Denial Management Specialist I. This is a grade 14 position. The successful applicant will work under moderate supervision to perform entry level billing/denial responsibilities. The expectations for this position shall include but not be limited to the following:
Must be comfortable making outbound calls to payors.
One (1) year follow-up / collections experience is strongly preferred.
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.
Review accuracy of payment to account Resolve discrepancy between insurance and billing.
Provide feedback on denial trends to leadership.
Work From Home (WFH): This is a WFH role. Applicant must live in Texas
Shift: 8-hour days, flex shift Monday through Friday

Requirements

• High School Diploma or equivalent
• 1-year medical billing or collections experience
• Requires working knowledge of Epic Resolute
• Must be comfortable making outbound calls to payors.

Nice To Haves

• 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.
• One (1) year follow-up / collections experience is strongly preferred.

Responsibilities

• Review, research and resolve basic coding denials. 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 basic 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.
• Makes necessary adjustments as required by plan reimbursement.
• Attend coding and billing in-services to gain proven knowledge of CPT and ICD-10 coverage policies, internal revenue cycle coding processes and the billing practices of specialty service lines.
• Requires knowledge of carrier specific claim appeal guidelines. This includes Claim Logic, internet, and or paper/fax processes.
• 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.

Benefits

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100%25 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

What This Job Offers

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