Clinical Denial Management Specialist III

UT Southwestern Department of Dermatology; Dallas (TX); Ibrido; USD 60.000 - 80.000; Tempo pieno

Vantaggi offerti da questo lavoro

PPO medical plan

Preventive care coverage

Paid time off

Retirement programs

Paid parental leave

Wellness programs

Tuition reimbursement

PSLF qualified employer

Descrizione del lavoro

UT Southwestern Medical Center in Dallas, TX is seeking a Clinical Denial Management Specialist III to perform advanced billing/denial work under moderate supervision. The role requires 3+ years of clinical follow-up experience with complex surgical procedures and familiarity with E/M, CPT, or diagnoses coding.

The ideal candidate has EPIC experience, and CPC certification is a plus. This hybrid role offers work-from-home options with preference for candidates near the DFW area, plus a

Competenze

• 3+ years medical billing or collections experience.
• Ability to work clinical denials for complex E/M services and procedures.
• Strong knowledge of medical claims recovery rules and regulations.
• Experience with EPIC is highly preferred.

Mansioni

• Review and resolve accounts promptly per department guidelines.
• Investigate invoices and resolve denials following payer guidelines.
• Review documentation to research denials for E/M and related procedures.
• Call insurers to obtain status updates and resolve reimbursement discrepancies.
• Create and submit appeals with documentation for clinical and coding denials.
• Review posted payments, reconcile discrepancies, and adjust as needed.
• Identify denial trends and provide feedback to leadership.
• Perform other duties as assigned by leadership.

Conoscenze

Clinical denials

EPIC experience

Excel proficiency

Analytical thinking

Communication skills

Formazione

High School Diploma

Coding certifications (CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, CCS, CCA)

Strumenti

MS Excel

Descrizione del lavoro

Location: Dallas, TX
Location Type: Hybrid
Job Number: 984570
Category: Insurance/Billing
Posted 1 Day Ago

Job Summary

The Revenue Cycle Department at UT Southwestern Medical Center has an opportunity available for a Clinical Denial Management Specialist III. The successful candidate will work under moderate supervision to perform advanced level billing/denial responsibilities. The ideal applicant will have three (3) or more years of Clinical follow-up experience of complex minor and/or major surgical procedures. Preference given to applicants with experience in General Surgery & Multi-specialty Surgery. Clinical Follow-up experience using EPIC is highly preferred. CPC certification is a plus.

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 employees. Ranked as the No. 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you’ll discover a culture of teamwork, professionalism, and a rewarding career!

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

Work Details

• Work from home (WFH): This will be a 100% WFH position. Preference given to candidates who live within fifty (50) miles of the DFW area. WFH details shall be discussed as part of the interview process.
• Shift: 8-hour semi-flex shift, Monday through Friday. The shift details shall be discussed as part of the interview process.

Duties

• Collections – Review and resolve accounts promptly per department guidelines.
• Following policies and guidelines regarding resolving invoices.
• Review documentation – to review, research coding denials for minor/major surgical procedures and any related to E&M, CPT, Diagnosis, or modifier.
• Call insurance to obtain status update, to resolve complex denial and regarding reimbursement discrepancies.
• Create and submit appeals for clinical and coding denials in accordance with payer guidelines, supported by appropriate documentation.
• Review accuracy of payment posted to account, reconcile discrepancies, and make necessary adjustment based on Explanation of benefits.
• Resolve the discrepancy between insurance and billing.
• Identify and provide feedback on denial trends to leadership.
• Perform other duties as assigned by leadership.

Required

• Education High School Diploma Or equivalent or
• Experience 3 years medical billing or collections experience. and Must demonstrate the ability to work clinical denials for complex E&M services, diagnostic studies, and/or minor surgical procedures and Must demonstrate a strong knowledge of medical claims recovery and/or collections rules and regulations

Preferred

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

Knowledge, Skills And Abilities

• 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 requires working knowledge of MS Excel.

Physical Requirements / Working Conditions

• Talking

• Clinical Setting
• Office Setting

Salary Information

Salary Is Commensurate With Education, Skills, And Relevant Experience.

Security and EEO Statement

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.