Clinical Denial Management Specialist III

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 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 at UT Southwestern Medical Center has a new 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 is given to applicants with experience in Surgical Oncology, Surgical Transplant, and Oral & Maxillofacial surgery.

Clinical Follow up experience using EPIC is highly preferred. CPC certification is a plus.

• Work from home (WFH): This will be a 100% WFH position. Preference given to candidates who live within fifty 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.

• 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 based on payer guidelines, on coding denials.
• Review accuracy of payment to account, reconcile and make necessary adjustment as per EOB.
• Resolve the discrepancy between insurance and billing.
• Provide feedback on denial trends to leadership.
• Perform other duties as assigned by leadership.
• 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…