Clinical Denial Management Specialist III

UT Southwestern Medical Center
Dallas, TX
Category Healthcare
Remote
Job Description
The Clinical Denial Management Specialist III position at UT Southwestern Medical Center involves performing advanced level billing/denial responsibilities. The successful candidate will work under moderate supervision to review and resolve complex coding denials for surgical procedures and E&M services. The ideal applicant will have three or more years of Clinical follow-up experience and prefer experience in Surgical Oncology, Surgical Transplant, and Oral & Maxillofacial surgery.

Requirements

  • 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 for clinical and coding denials in accordance with payer guidelines, supported by appropriate documentation
  • Review accuracy of payment posted to account, reconcile discrepancies, and make necessary adjustment based on Explanation of benefits.
  • Resolve the discrepancy between insurance and billing.
  • Identify and provide feedback on denial trends to leadership.
  • Perform other duties as assigned by leadership.

Benefits

  • PPO medical plan
  • 100% coverage for preventive healthcare-no copay
  • Paid Time Off
  • 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
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