Clinial Denial Management Specialist III MSRDP

UT Southwestern Medical Center - Dallas, TX

Full-time - Mid Level

Remote - Dallas, TX

Hospitals

About the position

The Clinical Denial Management Specialist III at UT Southwestern is responsible for advanced billing and denial management tasks within the Revenue Cycle Department. This role involves resolving complex denials related to surgical procedures and ensuring accurate payment reconciliation. The specialist will work under moderate supervision, utilizing their expertise in medical billing and coding to improve collections and minimize denials.

Responsibilities

• Resolve denials and reconcile expected payments on fee schedules versus actual payments.
• Review documentation and call insurance companies to resolve complex denials and obtain status updates.
• Create and submit appeals based on payer guidelines for complex coding denials.
• Identify denial, payment, and coding trends to decrease denials and maximize collections.
• Interpret Managed Care contracts and Medicare/Medicaid rules to ensure proper reimbursement.
• Provide feedback to Front End Operations regarding billing discrepancies.

Requirements

• High School Diploma or equivalent (GED) required.
• 2 years of medical billing or collections experience required.
• Demonstrated ability to work with clinical denials for complex E&M services and surgical procedures required.
• Strong knowledge of medical claims recovery and collections rules and regulations required.

Nice-to-haves

• Associate's Degree or Bachelor's Degree may be used in lieu of experience.
• Master's Degree may be used in lieu of experience.
• Valid certifications such as CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, CCS, CCA upon hire.

Benefits

• PPO medical plan available day one at no cost for full-time employee-only coverage.
• 100% coverage for preventive healthcare with 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.