Clinical Denial Management Specialist III

UT Southwestern Medical Center•Dallas, TX

21h•Remote

About The Position

The Revenue Cycle Department at UT Southwestern Medical Center is hiring a Clinical Denial Management Specialist III to perform advanced billing and denial-management responsibilities under moderate supervision. The role focuses on reviewing, researching, and resolving complex clinical and coding denials involving E&M services, diagnostic studies, endoscopic and interventional procedures, and minor or major surgery. The specialist prepares and submits appeals, contacts payers, reviews clinical documentation, assesses coding and reimbursement, reconciles account discrepancies, and identifies denial and payment trends to help improve collections. This position is 100% work from home. Preference is given to candidates who live within 50 miles of the Dallas-Fort Worth area. The schedule is an 8-hour semi-flex shift, Monday through Friday; specific shift details are discussed during the interview process. The role serves as a resource to team leads, compliance auditors, medical collectors, and other clinical denial management specialists. Salary is commensurate with education, skills, and relevant experience.

Requirements

High school diploma or equivalent.
Three years of medical billing or collections experience.
Demonstrated ability to work clinical denials for complex E&M services, diagnostic studies, and/or minor surgical procedures.
Strong knowledge of medical claims recovery and/or collections rules and regulations.
Ability to analyze problems, develop solutions, and implement new procedures.
Ability to prioritize large volumes of work, with good organizational, flexibility, and analytical skills when resolving complex unpaid claims.
Good communication skills, including clear and concise written and oral communication with payers, providers, and billing staff.
Working knowledge of MS Excel.
Knowledge of carrier-specific claim appeal guidelines and claim submission processes, including Claim Logic, internet, and paper/fax processes.
Analytical and decision-making skills to determine which clinical information is needed to support an appeal.
Knowledge of CPT and ICD-10 coverage policies, internal revenue cycle coding processes, and specialty service-line billing practices.
Ability to read and interpret E&M notes, complex diagnostic study results, endoscopic and interventional results, and/or major surgical operative notes.
Knowledge of specialty-specific service-line documentation requirements.
Familiarity with Medicare and Medicaid teaching physician documentation billing rules within 60 days of hire.

Nice To Haves

Three or more years of clinical follow-up experience with complex minor and/or major surgical procedures.
Experience in General Surgery and multi-specialty surgery.
Clinical follow-up experience using EPIC.
A coding certification such as CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, CCS, or CCA; the listed certifications are required upon hire if applicable.
An associate, bachelor's, or master's degree; preferred qualifications may be considered in lieu of experience.

Responsibilities

Review, research, and resolve coding denials for complex diagnostic studies, endoscopic and interventional procedures, and major surgical procedures, including denials related to E&M, CPT, diagnosis, and modifiers.
Prepare and submit claim appeals for clinical and coding denials in accordance with payer guidelines and supporting documentation requirements.
Contact payers by website, phone, correspondence, or other claim processes to obtain claim status, resolve complex denials, and address reimbursement discrepancies.
Interpret managed care contracts and Medicare and Medicaid rules and regulations to ensure proper reimbursement and collections.
Review clinical documentation, including E&M notes, diagnostic study results, endoscopic and interventional results, and operative notes; confirm or change billed CPT codes, diagnosis codes, and modifiers as appropriate.
Review account payment accuracy, reconcile discrepancies, and make adjustments based on explanations of benefits and plan reimbursement.
Resolve discrepancies between insurance and billing and review and resolve accounts promptly in accordance with department guidelines and policies.
Identify denial, payment, coding, and reimbursement trends and provide feedback to leadership to reduce denials and maximize collections.
Serve as a resource to FERC Team Leads, Compliance Auditors, Medical Collectors, and MSRDP Clinical Denials Management Specialists I and II.
Perform other duties as assigned.

Benefits

PPO medical plan, available day one at no cost for full-time employee-only coverage.
100% coverage for preventive healthcare with 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.
Paid holidays.
On-site childcare.
Merit increases.