Clinical Denial Management Specialist Iii Msrdp - Revenue Cycle

Clinical Denial Management Specialist III

The Department of Revenue Cycle has an available position for the role of Clinical Denial Management Specialist III. This position handles physician denials for providers who see patients at UT Southwestern, CMC, Parkland, Presbyterian Dallas, Presbyterian Frisco, and clinics throughout the DFW area. This position will handle insurance denials related to CPAT codes, diagnoses codes, modifiers, Place of service and payer policies (i.e. bundling, level of service, and medical necessity denials). Ideal candidate would have an understanding of both coding/billing rules rules and denials (CPC preferred, but not required. This is a diverse team who are always willing to share information and help each other succeed.

• Preferred skills: Excel, Word, Outlook, EPIC, Teams, etc.,
• Work From Home (WFH): This is a WFH position, estimated at 95%. Candidate should live in the Greater DFW area.
• Shift: Flex shift start between 0600-0900

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.

• High School Diploma or equivalent
• And three (3) years medical billing or collections experience.
• Must demonstrate the ability to work Clinical Denials for complex E&M services, complex diagnostic studies, endoscopic, interventional and/or surgical procedures.
• Must demonstrate a strong knowledge of medical claims recovery and/or collections rules and regulations.
• Coding certifications (CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, CCS, CCA) and/or degrees (associate level, bachelor level, master level) preferred and may be considered in lieu of experience.

• Works under moderate supervision to perform advanced level billing/denial 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.
• Requires knowledge of carrier specific claim appeal guidelines. This includes Claim Logic, internet, and paper/fax processes. Requires proven analytical, and decision-making skills to determine what selective clinical information must be submitted to properly appeal the denial. Requires proven knowledge of CPT and ICD-10 coverage policies, internal Revenue Cycle coding processes and the billing practices of the specialty service line. This position 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. Based on the documentation review, confirm, or change the billed CPT code(s), diagnosis code(s) and modifiers (if applicable) in order to attain denial resolution. 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.
• Serves as a resource to the FERC Team Leads, Compliance Auditors, Medical Collectors and MSRDP Clinical DenialsManagement Specialist I & II. Requires a billing and coding knowledge level that provides guidance on and resolution to resolve claim denials and rejections.
• Makes necessary adjustments as required by plan reimbursement.
• 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.

• Work requires working knowledge of MS Excel.
• Work requires ability to analyze problems, develop solutions, and implement new procedures.
• Work requires ability to prioritize large volumes of work. Work requires good organizational, flexibility and analytical skills when resolving more complex unpaid claims.
• Work requires good communication skills.

Work is performed primarily in office area. 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