Clinical Denial Management Specialist I

Clinical Denial Management Specialist I

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 number 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!

The Revenue Cycle Department team has a new opportunity available for the role of Clinical Denial Management Specialist I. This is a grade 14 position. The successful applicant will work under moderate supervision to perform entry level billing/denial responsibilities. The expectations for this position shall include but not be limited to the following:

• Must be comfortable making outbound calls to payors.
• One (1) year follow-up / collections experience is strongly preferred.
• Reconcile expected payment and make necessary adjustments as required by plan reimbursement.
• Review and interpret documentation.
• Prepare and submit appeals to payers based on payor guidelines.
• Review accuracy of payment to account.
• Resolve discrepancy between insurance and billing.
• Provide feedback on denial trends to leadership.
• Work From Home (WFH): This is a WFH role. Applicant must live in Texas.
• Shift: 8-hour days, flex shift Monday through Friday

UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:

• 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

Learn more about these and other UTSW employee benefits!

Required Education: High School Diploma or equivalent

Experience: 1-year medical billing or collections experience and Requires working knowledge of Epic Resolute

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

Job Duties:

• Review, research and resolve basic coding denials. 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 basic 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.
• Makes necessary adjustments as required by plan reimbursement.
• Attend coding and billing in-services to gain proven knowledge of CPT and ICD-10 coverage policies, internal revenue cycle coding processes and the billing practices of specialty service lines.
• Requires knowledge of carrier specific claim appeal guidelines. This includes Claim Logic, internet, and or paper/fax processes.
• 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.

EEO 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.