Clinical Denial Management Specialist II MSRDP - Revenue Cycle - (Job Number: 230000DB)

UT Southwestern Medical Center; Dallas (TX); Remote; USD 50,000 - 75,000; Full time

Job summary

UT Southwestern Medical Center seeks a Clinical Denial Management Specialist II to manage and resolve coding denials for various medical services. The role requires extensive knowledge of medical billing, coding regulations, and analytical skills to maximize billing collections. Candidates must reside in Texas and work from home, complying with a COVID-19 vaccination mandate.

Qualifications

• 2 years medical billing or collections experience.
• Ability to work clinical denials for E&M services.
• Knowledge of medical claims recovery rules.

Responsibilities

• Review and resolve coding denials for E&M services.
• Contact payers regarding claims denied for coding reasons.
• Interpret Managed Care contracts to ensure proper reimbursement.

Skills

analytical skills

decision-making skills

communication skills

Education

High School diploma or equivalent

Coding certifications preferred

Tools

EPIC knowledge

Job description

Clinical Denial Management Specialist II MSRDP - Revenue Cycle - (Job Number: 230000DB)

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.

COVID-19 Mandate

Compliance with the COVID-19 vaccine mandate enforced by the Centers for Medicare and Medicaid (CMS) is a requirement for this position. Federal law requires individuals holding this position to be fully vaccinated or have an approved exemption for certain medical, disability, or religious reasons. Individuals who do not meet CMS vaccination requirements are not eligible and should not apply for this position but are encouraged to apply for other non-healthcare positions at UT Southwestern for which they qualify.

The duties for this position may include but not be limited to the following:

• Internal medicine cases
• Pediatrics
• Radiology
• Family Medicine
• Multi-Specialty in Follow-up
• Appeals
• Coding
• EPIC knowledge
• Coding certification preferred

This is a work from home (WFH) position. Candidates must live within the state of Texas. Details regarding this shall be discussed as part of the interview process.

EXPERIENCE/EDUCATION:

REQUIRED:

• High School diploma or equivalent and two (2) 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.
• Coding certifications (CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, CCS, CCA) and/or degrees (associate level, bachelor level, master level) preferred and may be used in lieu of experience.

JOB DUTIES:

• Review, research and resolve coding denials for E&M services, diagnostic studies, and minor 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 moderate complexity 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 or 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 moderate complex coding denials.
• Read and interpret E&M notes, diagnostic study results and or minor procedure 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.
• 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.

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. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; sex; including sexual harassment; age; disability; genetic information; citizenship status; and protected veteran status. In addition, it is UT Southwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.

!*!

JOB SUMMARY:

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.

COVID-19 Mandate

Compliance with the COVID-19 vaccine mandate enforced by the Centers for Medicare and Medicaid (CMS) is a requirement for this position. Federal law requires individuals holding this position to be fully vaccinated or have an approved exemption for certain medical, disability, or religious reasons. Individuals who do not meet CMS vaccination requirements are not eligible and should not apply for this position but are encouraged to apply for other non-healthcare positions at UT Southwestern for which they qualify.

For COVID-19 vaccine information, applicants should visit https://www.utsouthwestern.edu/covid-19/work-on-campus/

The duties for this position may include but not be limited to the following:

• Internal medicine cases
• Pediatrics
• Radiology
• Family Medicine
• Multi-Specialty in Follow-up
• Collections experience
• Appeals
• Coding
• EPIC knowledge
• Coding certification preferred

This is a work from home (WFH) position. Candidates must live within the state of Texas. Details regarding this shall be discussed as part of the interview process.

EXPERIENCE/EDUCATION:

REQUIRED:

• High School diploma or equivalent and two (2) 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.
• Coding certifications (CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, CCS, CCA) and/or degrees (associate level, bachelor level, master level) preferred and may be used in lieu of experience.

JOB DUTIES:

• Review, research and resolve coding denials for E&M services, diagnostic studies, and minor 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 moderate complexity 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 or 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 moderate complex coding denials.
• Read and interpret E&M notes, diagnostic study results and or minor procedure 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.
• 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.

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. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; sex; including sexual harassment; age; disability; genetic information; citizenship status; and protected veteran status. In addition, it is UT Southwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.

5323 Harry Hines Blvd (5323H)
5323 Harry Hines Blvd
Dallas , 75390

About the company

The University of Texas Southwestern Medical Center is a public academic health science center in Dallas, Texas.

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