Clinical Denial Management Specialist III

UT Southwestern Medical Center • Dallas, TX

5h • Onsite

About The Position

Works under moderate supervision to perform advanced level billing/denial responsibilities. UT Southwestern is a world-renowned medical and research center committed to excellence, innovation, teamwork, and compassion. Ranked as the number 1 hospital in Dallas-Fort Worth, we invest in our employees with opportunities for career growth and development. We offer a highly competitive benefits package.

Requirements

• High School Diploma Or equivalent
• 3 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
• Requires knowledge of carrier specific claim appeal guidelines. This includes Claim Logic, internet, and paper/fax processes.
• Requires proven analytical, and decision making skills
• Requires proven knowledge of CPT and ICD-10 coverage policies, internal revenue cycle coding processes and the billing practices of the specialty service line.
• Requires clear and concise written and oral communication with payors, providers, and billing staff to insure resolution of complex coding denials.
• Requires the ability to read and interpret E&M notes, complex diagnostic study results, endoscopic and interventional results and/or major surgical operative notes.
• 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.

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.
• CPC (CERT PROFESSIONAL CODER) Upon Hire
• CPMA (Cert Prof Medical Auditor) Upon Hire
• CMC (CERT MEDICAL CODER) Upon Hire
• ART (ASSOC RECORDS ADMIN) Upon Hire
• RRA (REGISTERED RECORDS ADMIN) Upon Hire
• RHIA (REGD HEALTH INFO ADMINIST) Upon Hire
• RHIT (REGD HEALTH INFO TECHNOLO) Upon Hire
• CCS (CERT CODING SPECIALIST) Upon Hire
• CCA (Cert Coding Associate) Upon Hire

Responsibilities

• Review, research and resolve coding denials for complex diagnostic studies, endoscopic, interventional and/or major 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 complex 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.
• Determine what selective clinical information must be submitted to properly appeal the denial.
• Confirm or change the billed CPT code(s), diagnosis code(s) and modifiers (if applicable) in order to attain denial resolution.
• Serves as a resource to the FERC Team Leads, Compliance Auditors, Medical Collectors and MSRDP Clinical Denials Management Specialist I & II.
• Makes necessary adjustments as required by plan reimbursement.
• Performs 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-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: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees