Is the Clinical Denial Management Specialist II position at UT Southwestern Medical Center fully remote?

Yes, this Clinical Denial Management Specialist II position at UT Southwestern Medical Center is a remote position. The role is available for candidates in United States.

Is this a full-time or part-time Clinical Denial Management Specialist II role?

This is a full-time Clinical Denial Management Specialist II position at UT Southwestern Medical Center.

What benefits does UT Southwestern Medical Center offer for this position?

UT Southwestern Medical Center offers the following benefits: Paid Time Off, Wellness Programs, Tuition Reimbursement.

How do I apply for the Clinical Denial Management Specialist II position at UT Southwestern Medical Center?

You can apply for this Clinical Denial Management Specialist II position by clicking the "Apply Now" button on this page, which will take you to UT Southwestern Medical Center's application portal.

Clinical Denial Management Specialist II at UT Southwestern Medical Center

United States

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 <a href="https://www.utsouthwestern.edu/newsroom/articles/year-2022/july-us-news-best-hospital.html" target="_blank">U.S. News & World Report</a>, 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!  JOB SUMMARY The Revenue Cycle Department team has a new opportunity available for the role of Clinical Denial Management Specialist II. Works under intermediate level billing/denial responsibilities. The expectations for this position shall include but not be limited to the following:<o:p></o:p><ul style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:"Open Sans", "Segoe UI", Frutiger, "Frutiger Linotype", "Dejavu Sans", "Helvetica Neue", Arial, sans-serif;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0in 0px 12px;orphans:2;padding:0px 0px 0px 20px;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;" type="disc"><li class="MsoNormal" style="line-height:1.25;">Two (2) years' follow-up / collections experience is strongly preferred.<o:p></o:p></li><li class="MsoNormal" style="line-height:1.25;">Review, research, and resolve denial of professional claims related to CPT codes, place of service, modifiers, and payer policies.<o:p></o:p></li><li class="MsoNormal" style="line-height:1.25;">Reconcile expected payment and make necessary adjustments as required by plan reimbursement. Review and interpret documentation.<o:p></o:p></li><li class="MsoNormal" style="line-height:1.25;">Prepare and submit appeals to payers based on payor guidelines.<o:p></o:p></li><li class="MsoNormal" style="line-height:1.25;">Contact payers regarding reimbursement of denied claims.<o:p></o:p></li><li class="MsoNormal" style="line-height:1.25;">Review accuracy of payment to account Resolve discrepancy between insurance and billing.<o:p></o:p></li><li class="MsoNormal" style="line-height:1.25;">Provide feedback on denial trends to leadership.<o:p></o:p></li></ul><p class="MsoNormal" style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:"Open Sans", "Segoe UI", Frutiger, "Frutiger Linotype", "Dejavu Sans", "Helvetica Neue", Arial, sans-serif;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">Shift: Flex shift, start time between 0600-0900.<o:p></o:p><p class="MsoNormal" style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:"Open Sans", "Segoe UI", Frutiger, "Frutiger Linotype", "Dejavu Sans", "Helvetica Neue", Arial, sans-serif;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">Work from home (WFH): This is a work from home position. Applicants must live in the state of Texas. Additional details shall be discussed as part of the interview process.  <p class="MsoNormal" style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:"Open Sans", "Segoe UI", Frutiger, "Frutiger Linotype", "Dejavu Sans", "Helvetica Neue", Arial, sans-serif;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">BENEFITS UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:<ul><li>PPO medical plan, available day one at no cost for full-time employee-only coverage</li><li>100%25 coverage for preventive healthcare-no copay</li><li>Paid Time Off, available day one</li><li>Retirement Programs through the Teacher Retirement System of Texas (TRS)</li><li>Paid Parental Leave Benefit</li><li>Wellness programs</li><li>Tuition Reimbursement</li><li>Public Service Loan Forgiveness (PSLF) Qualified Employer</li><li><a href="http://jobs.utsouthwestern.edu/benefits/#top" target="_blank">Learn more about these and other UTSW employee benefits!</a></li></ul>EXPERIENCE AND EDUCATION Required<ul><li>Education High School Diploma or equivalent or   </li></ul><ul><li>Experience 2 years medical billing or collections experience and  Must demonstrate the ability to work clinical denials for complex E&M services, diagnostic studies, and/or minor surgical procedures and  Must demonstrate a strong knowledge of medical claims recovery and/or collections rules and regulations   </li></ul>Preferred<ul><li>Education Coding certifications (CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, CCS, CCA) and/or degrees (associate level, bachelor level, master level) are preferred and may be considered in lieu of experience.   </li></ul><ul><li>Licenses and Certifications (CPC) CERT PROFESSIONAL CODER Upon Hire or (CPMA) Cert Prof Medical Auditor Upon Hire or (CMC) CERT MEDICAL CODER Upon Hire or (ART) ASSOC RECORDS ADMIN Upon Hire or (RRA) REGISTERED RECORDS ADMIN Upon Hire or (RHIA) REGD HEALTH INFO ADMINIST Upon Hire or (RHIT) REGD HEALTH INFO TECHNOLO Upon Hire or (CCS) CERT CODING SPECIALIST Upon Hire or (CCA) Cert Coding Associate Upon Hire   </li></ul>JOB DUTIES<ul><li>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.</li><li>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.</li><li>Requires knowledge of carrier specific claim appeal guidelines. This includes Claim Logic, internet, and or 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 moderate complex coding denials.</li><li>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.</li><li>Makes necessary adjustments as required by plan reimbursement.</li><li>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.</li><li>Performs other duties as assigned.</li></ul>SECURITY AND EEO STATEMENT Security This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information. EEO 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.

Apply Now

Remote Opportunity

Clinical Denial Management Specialist II

Q: What are the main requirements for the Clinical Denial Management Specialist II role?

Key requirements include: 2 years' follow-up / collections experience is strongly preferred, Review, research, and resolve denial of professional claims related to CPT codes, place of service, modifiers, and payer policies, Reconcile expected payment and make necessary adjustments as required by plan reimbursement, and more.

Join UT Southwestern Medical Center as a mid professional working remotely from United States. Explore the role, benefits, and apply in one place.

Clinical Denial Management Specialist II

UT Southwestern Medical Center

Full Time

$80,000 - $120,000*

7 months ago

WHY UT SOUTHWESTERN? With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion.

United States

Operations

Mid

Denial management

Collections

CPT codes

+5 more

Job Description

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!

JOB SUMMARY
The Revenue Cycle Department team has a new opportunity available for the role of Clinical Denial Management Specialist II. Works under intermediate level billing/denial responsibilities. The expectations for this position shall include but not be limited to the following:

Two (2) years' follow-up / collections experience is strongly preferred.
Review, research, and resolve denial of professional claims related to CPT codes, place of service, modifiers, and payer policies.
Reconcile expected payment and make necessary adjustments as required by plan reimbursement. Review and interpret documentation.
Prepare and submit appeals to payers based on payor guidelines.
Contact payers regarding reimbursement of denied claims.
Review accuracy of payment to account Resolve discrepancy between insurance and billing.
Provide feedback on denial trends to leadership.

Shift: Flex shift, start time between 0600-0900.

Work from home (WFH): This is a work from home position. Applicants must live in the state of Texas. Additional details shall be discussed as part of the interview process.

BENEFITS
UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:

PPO medical plan, available day one at no cost for full-time employee-only coverage
100%25 coverage for preventive healthcare-no copay
Paid Time Off, available day one
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
Learn more about these and other UTSW employee benefits!

EXPERIENCE AND EDUCATION

Required

Education
High School Diploma or equivalent or

Experience
2 years medical billing or collections experience and
Must demonstrate the ability to work clinical denials for complex E&M services, diagnostic studies, and/or minor surgical procedures and
Must demonstrate a strong knowledge of medical claims recovery and/or collections rules and regulations

Preferred

Education
Coding certifications (CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, CCS, CCA) and/or degrees (associate level, bachelor level, master level) are preferred and may be considered in lieu of experience.

Licenses and Certifications
(CPC) CERT PROFESSIONAL CODER Upon Hire or
(CPMA) Cert Prof Medical Auditor Upon Hire or
(CMC) CERT MEDICAL CODER Upon Hire or
(ART) ASSOC RECORDS ADMIN Upon Hire or
(RRA) REGISTERED RECORDS ADMIN Upon Hire or
(RHIA) REGD HEALTH INFO ADMINIST Upon Hire or
(RHIT) REGD HEALTH INFO TECHNOLO Upon Hire or
(CCS) CERT CODING SPECIALIST Upon Hire or
(CCA) Cert Coding Associate Upon Hire

JOB DUTIES

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.
Requires knowledge of carrier specific claim appeal guidelines. This includes Claim Logic, internet, and or 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 moderate complex coding denials.
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.
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.

SECURITY AND EEO STATEMENT

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

EEO
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.

Requirements

2 years' follow-up / collections experience is strongly preferred
Review, research, and resolve denial of professional claims related to CPT codes, place of service, modifiers, and payer policies
Reconcile expected payment and make necessary adjustments as required by plan reimbursement
Review and interpret documentation
Prepare and submit appeals to payers based on payor guidelines
Contact payers regarding reimbursement of denied claims
Review accuracy of payment to account
Resolve discrepancy between insurance and billing

Benefits

Paid Time Off
Wellness Programs
Tuition Reimbursement

Skills

Denial management

Collections

CPT codes

modifiers

Payer policies

Claims Follow-up

Appeals Submission

Reimbursement Reconciliation

About AI-Estimated Salary

The salary range shown was not provided by the employer. Our AI has estimated it based on the job title, required experience, location, and industry standards (confidence: 70%). This estimate should be used as a general guide only and may not reflect the actual compensation. Always confirm salary details directly with the employer during the application process.

Ready to Apply?

Join UT Southwestern Medical Center today

Salary Range (AI-Estimated)*

$80,000 - $120,000

70% confidence

Posted 7 months ago

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