Clinical Denial Management Specialist III MSRDP
3 months ago
SUMMARY
:This Revenue Cycle Department has a new opportunity available for a talented Clinical Denial Management Specialist III. The ideal applicant will have 3+ years of follow-up experience of complex minor and/or major surgical procedures. Preferably someone who has been a specialist in OB/Gyn, Orthopedics, Neurosurgery, Otolaryngology, Urology, and Spine. The duties for this position will include but not be limited to the following areas of responsibility:
Collections – resolve denials Reconcile expected payment on fee schedule vs actual payment Following policy and guidelines regarding resolving invoices Review documentation Call insurance to resolve complex denial, obtain status Create and submit appeals Review accuracy of payment to account Resolve discrepancy between insurance and billing Provide feedback to Front End Operations This will be a 100% work home position. Details regarding this shall be discussed as part of the interview process.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.
EXPERIENCE | EDUCATION:
REQUIRED:
High School diploma 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
JOB DUTIES:
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 Denials Management 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.
KNOWLEDGE, SKILLS & ABILITIES:
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.
WORKING CONDITIONS:
Work is performed primarily in a general 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
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.
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Dallas, Texas, United States UT Southwestern Full timeAbout the RoleUT Southwestern is seeking a highly skilled Clinical Denial Management Specialist III MSRDP to join our Revenue Cycle Department. As a key member of our team, you will play a critical role in resolving complex medical billing and collections issues.Key ResponsibilitiesResolve denials and reconcile expected payment on fee schedule vs actual...
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