MSRDP Clinical Denial Management Specialist
UT Southwestern Medical Center, Dallas, TX
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
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
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
Performs other duties as assigned.
High school diploma or equivalent; associate’s
Four (4) years medical billing or collections
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
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.
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:
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.