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MSRDP Clinical Denial Management Specialist II Job in Dallas, Texas

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Job Title: MSRDP Clinical Denial Management Specialist II

Employer:UT Southwestern Medical Center
Type:Full-Time
Location:Dallas, TX
Date Posted:12/5/2018

MSRDP Clinical Denial Management Specialist II

UT Southwestern Medical Center, Dallas, TX

Full-Time

 

Take advantage of this opportunity to join UT Southwestern Medical Center – ranked one of the “Best Places to Work” by the Dallas Business Journal. Due to our continued growth, UT Southwestern Medical Center is seeking a MSRDP Clinical Denial Management Specialist II.

 

Job Duties:

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.

·         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.

·         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.

·         Performs other duties as assigned.

 

 

Requirements:

·         High school diploma or equivalent; associate’s degree preferred.

·         Four (4) years medical billing or collections experience.

·         Six (6) months must include denials management and proven knowledge of billing/coding guidelines for complex E&M services, diagnostic studies, and/or minor surgical procedures that encompasses CPT and ICD-10 codes, modifiers, and payer specific billing rules.

·         Experience in medical billing, accounts receivables, and/or collections within a healthcare or insurance environment required.

·         Knowledge of CMS 1500, ICD-10, and CPT coding. Requires working knowledge of Epic Resolute required.

·         Coding and multispecialty experience is highly preferred.

·         Knowledge of carrier specific claim appeal guidelines. This includes claim logic, internet, and or paper/fax processes.

·         Proven analytical, and decision making skills to determine what selective clinical information must be submitted to properly appeal the denial.

·         Proven knowledge of CPT and ICD-10 coverage policies, internal revenue cycle coding processes and the billing practices of the specialty service line.

·         Clear and concise written and oral communication with payers, providers, and billing staff to ensure resolution of moderate complex coding denials.

 

This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.

 

To learn more and to apply, please visit: https://jobs.utsouthwestern.edu/msrdpsp


About UT Southwestern Medical Center:

UT Southwestern Medical Center ranks among the top academic medical centers with more active Nobel Prize winners than any other medical school in the world. As a premier educational, clinical and research institution, UT Southwestern is home to more than 2,000 distinguished scientists, physicians and allied health professionals. Our University Hospital has achieved Magnet® recognition by the American Nurses Credentialing Center (ANCC), joining only 7% of hospitals in the United States.

 

UT Southwestern is an Affirmative Action/Equal Opportunity Employer. Women, minorities, veterans, and individuals with disabilities are encouraged to apply.

Applying

To learn more and to apply, please visit: https://jobs.utsouthwestern.edu/msrdpsp

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