Clinical Denial Management Specialist III

About the role

The Revenue Cycle Department at UT Southwestern Medical Center in Dallas is hiring a Clinical Denial Management Specialist III. The role works under moderate supervision on advanced billing and denial tasks, mostly from home. It suits someone with 3+ years of clinical follow-up experience on complex minor and/or major surgical procedures, with preference for General Surgery and multi-specialty surgery backgrounds.

Key responsibilities

• Review and resolve coding denials for complex minor/major surgical procedures, E&M, CPT, diagnosis and modifiers, including bundling, concurrent care, frequency and limited coverage denials
• Call insurers to get status updates and resolve complex denials and reimbursement discrepancies
• Create and submit appeals for clinical and coding denials in line with payer guidelines, supported by documentation
• Review posted payments, reconcile discrepancies against the Explanation of Benefits and adjust accounts as needed
• Identify and report denial trends to leadership
• Serve as a resource to FERC team leads, compliance auditors, medical collectors and lower-level specialists

Required profile

• High school diploma or equivalent
• 3 years of medical billing or collections experience
• Ability to handle clinical denials for complex E&M services, diagnostic studies and minor surgical procedures
• Strong knowledge of medical claims recovery and collections rules and regulations
• Preferred: CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, CCS or CCA certification, or an associate, bachelor or master's degree
• Preferred: CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, CCS or CCA certification upon hire

Required skills

• Knowledge of CPT and ICD-10 coverage policies and the internal revenue cycle
• Ability to read and interpret E&M notes, diagnostic study results and operative notes
• Working knowledge of MS Excel
• Clear written and oral communication with payors, providers and billing staff

What we offer

• 100% WFH position, with preference for candidates living within 50 miles of the DFW area
• 8-hour semi-flex schedule, Monday to Friday
• PPO medical plan day one, 100% coverage for preventive care, paid time off and paid parental leave
• Retirement through the Teacher Retirement System of Texas, wellness programs and tuition reimbursement